998 Skin BNF 70

Chapter 13
Skin
CONTENTS
1 Dry and scaling skin disorders page 999 7.1 Acne page 1042
2 Infections of the skin 1006 7.2 Rosacea 1048
2.1 Bacterial skin infections 1008 8 Scalp and hair conditions 1048
2.2 Fungal skin infections 1010 8.1 Alopecia 1049
2.3 Parasitic skin infections 1014 8.2 Hirsutism 1050
13 2.4 Viral skin infections 1016 9 Skin cleansers, antiseptics and desloughing
3 Inflammatory skin conditions 1016 agents 1050
Skin

3.1 Eczema and psoriasis 1016 9.1 Minor cuts and abrasions 1054
4 Perspiration 1038 10 Skin disfigurement 1055
4.1 Hyperhidrosis 1038 11 Superficial soft-tissue injuries and superficial
5 Photodamage 1039 thrombophlebitis 1055
6 Pruritis 1040 12 Warts and calluses 1055
7 Rosacea and acne 1041

have a limited but useful role where ready removal is

Skin conditions, management desirable.
Pastes are stiff preparations containing a high proportion
Vehicles of finely powdered solids such as zinc oxide and starch
The British Association of Dermatologists list of preferred suspended in an ointment. They are used for circumscribed
unlicensed dermatological preparations (specials) is lesions such as those which occur in lichen simplex, chronic
available at www.bad.org.uk/specials. eczema, or psoriasis. They are less occlusive than ointments
Both vehicle and active ingredients are important in the and can be used to protect inflamed, lichenified, or
treatment of skin conditions; the vehicle alone may have excoriated skin.
more than a mere placebo effect. The vehicle affects the Dusting powders are used only rarely. They reduce
degree of hydration of the skin, has a mild anti- friction between opposing skin surfaces. Dusting powders
inflammatory effect, and aids the penetration of active drug. should not be applied to moist areas because they can cake
Applications are usually viscous solutions, emulsions, or and abrade the skin. Talc is a lubricant but it does not
suspensions for application to the skin (including the scalp) absorb moisture; it can cause respiratory irritation. Starch is
or nails. less lubricant but absorbs water.
Collodions are painted on the skin and allowed to dry to
Dilution
leave a flexible film over the site of application.
The BP directs that creams and ointments should not
Creams are emulsions of oil and water and are generally
normally be diluted but that should dilution be necessary
well absorbed into the skin. They may contain an
care should be taken, in particular, to prevent microbial
antimicrobial preservative unless the active ingredient or
contamination. The appropriate diluent should be used and
basis is intrinsically bactericidal and fungicidal. Generally,
heating should be avoided during mixing; excessive dilution
creams are cosmetically more acceptable than ointments
may affect the stability of some creams. Diluted creams
because they are less greasy and easier to apply.
should normally be used within 2 weeks of preparation.
Gels consist of active ingredients in suitable hydrophilic
or hydrophobic bases; they generally have a high water
content. Gels are particularly suitable for application to the Suitable quantities of dermatological
face and scalp. preparations to be prescribed for
Lotions have a cooling effect and may be preferred to specific areas of the body
ointments or creams for application over a hairy area.
Lotions in alcoholic basis can sting if used on broken skin. Area of body Creams and Ointments Lotions
Shake lotions (such as calamine lotion) contain insoluble Face 15–30 g 100 ml
powders which leave a deposit on the skin surface.
Ointments are greasy preparations which are normally Both hands 25–50 g 200 ml
anhydrous and insoluble in water, and are more occlusive Scalp 50–100 g 200 ml
than creams. They are particularly suitable for chronic, dry Both arms or both legs 100–200 g 200 ml
lesions. The most commonly used ointment bases consist of
soft paraffin or a combination of soft, liquid, and hard Trunk 400 g 500 ml
paraffin. Some ointment bases have both hydrophilic and Groins and genitalia 15–25 g 100 ml
lipophilic properties; they may have occlusive properties on These amounts are usually suitable for an adult for twice daily
the skin surface, encourage hydration, and also be miscible application for 1 week. The recommendations do not apply to
with water; they often have a mild anti-inflammatory effect. corticosteroid preparations. For suitable quantities of corticosteroid
Water-soluble ointments contain macrogols which are freely preparations, see relevant table on p. 1021.
soluble in water and are therefore readily washed off; they
 BNF 70
Excipients and sensitisation
Excipients in topical products rarely cause problems. If a
patch test indicates allergy to an excipient, products
containing the substance should be avoided. The following
excipients in topical preparations are associated, rarely,
with sensitisation; the presence of these excipients is
indicated in the entries for topical products.
. Beeswax
. Benzyl alcohol
. Butylated hydroxyanisole
. Butylated hydroxytoluene
. Cetostearyl alcohol (including cetyl and stearyl alcohol)
. Chlorocresol
. Edetic acid (EDTA)
. Ethylenediamine
. Fragrances
. Hydroxybenzoates (parabens)
. Imidurea
. Isopropyl palmitate
. N-(3-Chloroallyl)hexaminium chloride (quaternium 15)
. Polysorbates
. Propylene glycol
. Sodium metabisulfite
. Sorbic acid
. Wool fat and related substances including lanolin
(purified versions of wool fat have reduced the problem)
1 Dry and scaling skin
disorders
Emollient and barrier
preparations
Borderline substances
The preparations marked ‘ACBS’ are regarded as drugs when
prescribed in accordance with the advice of the Advisory
Committee on Borderline Substances for the clinical
conditions listed. Prescriptions issued in accordance with
this advice and endorsed ‘ACBS’ will normally not be
investigated.
Emollients
Emollients soothe, smooth and hydrate the skin and are
indicated for all dry or scaling disorders. Their effects are
short lived and they should be applied frequently even after
improvement occurs. They are useful in dry and eczematous
disorders, and to a lesser extent in psoriasis. The choice of
an appropriate emollient will depend on the severity of the
condition, patient preference, and the site of application.
Some ingredients rarely cause sensitisation and this should
be suspected if an eczematous reaction occurs. The use of
aqueous cream as a leave-on emollient may increase the
risk of skin reactions, particularly in eczema.
Preparations such as aqueous cream and emulsifying
ointment can be used as soap substitutes for hand washing
and in the bath; the preparation is rubbed on the skin
before rinsing off completely. The addition of a bath oil may
also be helpful.
Urea is occasionally used with other topical agents such as
corticosteroids to enhance penetration of the skin.
Emollient bath and shower preparations
Emollient bath additives should be added to bath water;
hydration can be improved by soaking in the bath for 10–20
minutes. Some bath emollients can be applied to wet skin
undiluted and rinsed off. In dry skin conditions soap should
be avoided.
Dry and scaling skin disorders 999
The quantities of bath additives recommended for adults are
suitable for an adult-size bath. Proportionately less should
be used for a child-size bath or a washbasin; recommended
bath additive quantities for children reflect this.
Barrier preparations
Barrier preparations often contain water-repellent
substances such as dimeticone p. 1014 or other silicones.
They are used on the skin around stomas, bedsores, and
pressure areas in the elderly where the skin is intact. Where
the skin has broken down, barrier preparations have a
limited role in protecting adjacent skin. Barrier preparations
are not a substitute for adequate nursing care.
Nappy rash
The first line of treatment is to ensure that nappies are
changed frequently and that tightly fitting water-proof
pants are avoided. The rash may clear when left exposed to
the air and a barrier preparation, applied with each nappy
13
change, can be helpful. A mild corticosteroid such as
Skin
hydrocortisone 0.5% or 1% can be used if inflammation is
causing discomfort, but it should be avoided in neonates.
The barrier preparation should be applied after the
corticosteroid preparation to prevent further damage.
Preparations containing hydrocortisone should be applied
for no more than a week; the hydrocortisone should be
discontinued as soon as the inflammation subsides. The
occlusive effect of nappies and waterproof pants may
increase absorption of corticosteroids. If the rash is
associated with candidal infection, a topical antifungal such
as clotrimazole p. 1010 cream can be used. Topical
antibacterial preparations can be used if bacterial infection
is present; treatment with an oral antibacterial may
occasionally be required in severe or recurrent infection.
Hydrocortisone may be used in combination with
antimicrobial preparations if there is considerable
inflammation, erosion, and infection.
BARRIER PREPARATIONS
Barrier creams and ointments
INDICATIONS AND DOSE
For use as a barrier preparation
TO THE SKIN
▶ Child: (consult product literature)
▶ Adult: (consult product literature)
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Zinc and
Castor Oil Ointment, BP consists of zinc oxide 7.5%,
castor oil 50%, arachis (peanut) oil 30.5%, white beeswax
10% and cetostearyl alcohol 2%.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Beeswax, butylated hydroxyanisole, butylated
hydroxytoluene, cetostearyl alcohol (including cetyl and stearyl alcohol),
chlorocresol, fragrances, hydroxybenzoates (parabens), propylene
glycol, wool fat and related substances including lanolin
▶ Conotrane (Astellas Pharma Ltd)
Benzalkonium chloride 1 mg per 1 gram, Dimeticone 220 mg per
1 gram Conotrane cream | 100 gram G £0.88 DT price = £0.88 |
500 gram G £3.51
▶ Drapolene (Omega Pharma Ltd)
Benzalkonium chloride 100 microgram per 1 gram, Cetrimide
2 mg per 1 gram Drapolene cream | 100 gram G £1.76 |
200 gram G £2.86 | 350 gram G £4.28
▶ Siopel (Derma UK Ltd)
Cetrimide 3 mg per 1 gram, Dimeticone 1000 100 mg per 1
gram Siopel cream | 50 gram G £2.15
 1000 Dry and scaling skin disorders
▶ Sudocrem (Forest Laboratories UK Ltd)
Benzyl alcohol 3.9 mg per 1 gram, Benzyl benzoate 10.1 mg per 1
gram, Benzyl cinnamate 1.5 mg per 1 gram, Wool fat hydrous
40 mg per 1 gram, Zinc oxide 152.5 mg per 1 gram Sudocrem
antiseptic healing cream | 60 gram G £1.45 | 125 gram G
£2.15 | 250 gram G £3.67 | 400 gram G £5.25
Ointment
EXCIPIENTS: May contain Wool fat and related substances including
lanolin
▶ BARRIER CREAMS AND OINTMENTS (Non-proprietary)
Titanium dioxide 200 mg per 1 gram, Titanium peroxide 50 mg
per 1 gram, Titanium salicylate 30 mg per 1 gram | 30 gram
G £2.24
Castor oil 500 mg per 1 gram, Zinc Oxide 75 mg per 1 gram,
Arachis oil 305 mg per 1 gram | 500 gram G £4.99
▶ Brands may include Metanium ointment
Spray
CAUTIONARY AND ADVISORY LABELS 15
13 EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens), wool fat and related
substances including lanolin
Skin
▶ Sprilon (Ayrton Saunders Ltd)
Dimeticone 10.4 mg per 1 gram, Zinc oxide 125 mg per 1
gram Sprilon aerosol spray | 115 gram G £8.90 DT price = £8.90
EMOLLIENTS
Emollient bath and shower products,
antimicrobial-containing
INDICATIONS AND DOSE
DERMOL ® 200 SHOWER EMOLLIENT
Dry and pruritic skin conditions including eczema and
dermatitis
TO THE SKIN
▶ Adult: To be applied to the skin or used as a soap
substitute
DERMOL ® 600 ® BATH EMOLLIENT
Dry and pruritic skin conditions including eczema and
dermatitis
TO THE SKIN
▶ Child 1–23 months: 5–15 mL/bath, not to be used
undiluted
▶ Adult: 15–30 mL/bath, not to be used undiluted
DERMOL ® WASH EMULSION
Dry and pruritic skin conditions including eczema and
dermatitis
TO THE SKIN
▶ Adult: To be applied to the skin or used as a soap
substitute
EMULSIDERM ®
Dry skin conditions including eczema and ichthyosis
TO THE SKIN
▶ Adult: 7–30 mL/bath, alternatively, to be rubbed into
dry skin until absorbed
OILATUM ® PLUS
Topical treatment of eczema, including eczema at risk from
infection
TO THE SKIN
▶ Child 6–11 months: 1 mL/bath, not to be used undiluted
▶ Adult: 1–2 capfuls/bath, not to be used undiluted
Important safety information
FIRE HAZARD WITH PARAFFIN-BASED EMOLLIENTS
Emulsifying ointment or 50% Liquid Paraffin and 50%
White Soft Paraffin Ointment in contact with dressings
and clothing is easily ignited by a naked flame. The risk
is greater when these preparations are applied to large
areas of the body, and clothing or dressings become
soaked with the ointment. Patients should be told to
keep away from fire or flames, and not to smoke when
BNF 70
using these preparations. The risk of fire should be
considered when using large quantities of any paraffin-
based emollient.
These preparations make skin and surfaces slippery—
particular care is needed when bathing.
l DIRECTIONS FOR ADMINISTRATION Emollient bath
additives should be added to bath water; hydration can be
improved by soaking in the bath for 10–20 minutes. Some
bath emollients can be applied to wet skin undiluted and
rinsed off. Emollient preparations contained in tubs
should be removed with a clean spoon or spatula to
reduce bacterial contamination of the emollient.
Emollients should be applied in the direction of hair
growth to reduce the risk of folliculitis.
l PRESCRIBING AND DISPENSING INFORMATION
Preparations containing an antibacterial should be
avoided unless infection is present or is a frequent
complication. When prepared extemporaneously, the BP
states Aqueous Cream, BP consists of emulsifying
ointment 30%, phenoxyethanol 1% in freshly boiled and
cooled purified water. Hydrous Ointment, BP consists of
dried magnesium sulfate 0.5%, phenoxyethanol 1%, wool
alcohols ointment 50%, in freshly boiled and cooled
purified water.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ Dermol 200 (Dermal Laboratories Ltd)
Benzalkonium chloride 1 mg per 1 gram, Chlorhexidine
hydrochloride 1 mg per 1 gram, Isopropyl myristate 25 mg per 1
gram, Liquid paraffin 25 mg per 1 gram Dermol 200 shower
emollient | 200 ml p £3.55
▶ Dermol Wash (Dermal Laboratories Ltd)
Benzalkonium chloride 1 mg per 1 gram, Chlorhexidine
hydrochloride 1 mg per 1 gram, Isopropyl myristate 25 mg per 1
gram, Liquid paraffin 25 mg per 1 gram Dermol Wash cutaneous
emulsion | 200 ml p £3.55
Bath additive
EXCIPIENTS: May contain Acetylated lanolin alcohols, isopropyl
palmitate, polysorbates
▶ Dermol 600 (Dermal Laboratories Ltd)
Benzalkonium chloride 5 mg per 1 gram, Isopropyl myristate
250 mg per 1 gram, Liquid paraffin 250 mg per 1 gram Dermol
600 bath emollient | 600 ml p £7.55
▶ Emulsiderm (Dermal Laboratories Ltd)
Benzalkonium chloride 5 mg per 1 gram, Isopropyl myristate
250 mg per 1 gram, Liquid paraffin 250 mg per 1
gram Emulsiderm emollient | 300 ml p £3.85 | 1000 ml p £12.00
▶ Oilatum Plus (GlaxoSmithKline Consumer Healthcare)
Benzalkonium chloride 60 mg per 1 gram, Liquid paraffin light
525 mg per 1 gram, Triclosan 20 mg per 1 gram Oilatum Plus bath
additive | 500 ml G £6.98
Emollient bath and shower products,
colloidal oatmeal-containing
INDICATIONS AND DOSE
Endogenous and exogenous eczema | Xeroderma | Ichthyosis
TO THE SKIN
▶ Child 2–17 years: 20–30 mL/bath, alternatively apply to
wet skin and rinse
▶ Adult: 20–30 mL/bath, alternatively apply to wet skin
and rinse
 BNF 70 Dry and scaling skin disorders 1001

Pruritus of the elderly associated with dry skin
TO THE SKIN
▶ Elderly: 20–30 mL/bath, alternatively apply to wet skin
and rinse
Important safety information
These preparations make skin and surfaces slippery—
particular care is needed when bathing.
l DIRECTIONS FOR ADMINISTRATION Emollient bath
additives should be added to bath water; hydration can be
improved by soaking in the bath for 10–20 minutes. Some
bath emollients can be applied to wet skin undiluted and
rinsed off. Emollient preparations contained in tubs
should be removed with a clean spoon or spatula to
reduce bacterial contamination of the emollient.
Emollients should be applied in the direction of hair
growth to reduce the risk of folliculitis.
DOUBLEBASE ® EMOLLIENT SHOWER GEL
Dry, chapped, or itchy skin conditions
TO THE SKIN
▶ Child: To be applied to wet or dry skin and rinse, or
apply to dry skin after showering
▶ Adult: To be applied to wet or dry skin and rinse, or
apply to dry skin after showering
E45 ® WASH CREAM
Endogenous and exogenous eczema, xeroderma, and
ichthyosis
TO THE SKIN
▶ Child: To be used as a soap substitute
▶ Adult: To be used as a soap substitute
Pruritus of the elderly associated with dry skin
TO THE SKIN
▶ Elderly: To be used as a soap substitute
E45 ® BATH OIL 13
Endogenous and exogenous eczema, xeroderma, and

Skin
l MEDICINAL FORMS ichthyosis
There can be variation in the licensing of different medicines TO THE SKIN
containing the same drug. ▶ Adult: 15 mL/bath, alternatively, to be applied to wet
Bath additive skin and rinse
EXCIPIENTS: May contain Beeswax, fragrances
Pruritus of the elderly associated with dry skin
▶ EMOLLIENT BATH AND SHOWER PRODUCTS, COLLOIDAL
TO THE SKIN
OATMEAL-CONTAINING (Non-proprietary) 250 ml (ACBS) £4.49
▶ Brands may include Aveeno bath oil ▶ Elderly: 15 mL/bath, alternatively, to be applied to wet
skin and rinse
HYDROMOL ® BATH AND SHOWER EMOLLIENT
Emollient bath and shower products, Dry skin conditions | Eczema | Ichthyosis
TO THE SKIN
paraffin-containing ▶ Child 1 month–11 years: 0.5–2 capfuls/bath, alternatively
apply to wet skin and rinse
INDICATIONS AND DOSE ▶ Child 12–17 years: 1–3 capfuls/bath, alternatively apply
AQUAMAX ® WASH to wet skin and rinse
Dry skin conditions ▶ Adult: 1–3 capfuls/bath, alternatively apply to wet skin
TO THE SKIN and rinse
▶ Child: To be applied to wet or dry skin and rinse Pruritus of the elderly
▶ Adult: To be applied to wet or dry skin and rinse TO THE SKIN
CETRABEN ® BATH ▶ Elderly: 1–3 capfuls/bath, alternatively apply to wet
Dry skin conditions, including eczema skin and rinse
TO THE SKIN LPL 63.4 ®
▶ Child 1 month–11 years: 0.5–1 capful/bath, alternatively, Dry skin conditions
to be applied to wet skin and rinse TO THE SKIN
▶ Adult: 1–2 capfuls/bath, alternatively, to be applied to ▶ Child 1 month–11 years: 0.5–2 capfuls/bath, alternatively,
wet skin and rinse to be applied to wet skin and rinse
DERMALO ® ▶ Child 12–17 years: 1–3 capfuls/bath, alternatively, to be
Dermatitis | Dry skin conditions including eczema applied to wet skin and rinse
TO THE SKIN ▶ Adult: 1–3 capfuls/bath, alternatively, to be applied to
▶ Child 1 month–11 years: 5–10 mL/bath, alternatively, to wet skin and rinse
be applied to wet skin and rinse OILATUM ® EMOLLIENT BATH ADDITIVE
▶ Child 12–17 years: 15–20 mL/bath, alternatively, to be Dry skin conditions including dermatitis, and ichthyosis
applied to wet skin and rinse TO THE SKIN
▶ Adult: 15–20 mL/bath, alternatively, to be applied to ▶ Child 1 month–11 years: Apply 0.5–2 capfuls/bath,
wet skin and rinse alternatively, to be applied to wet skin and rinse
Pruritus of the elderly ▶ Child 12–17 years: 1–3 capfuls/bath, alternatively, to be
TO THE SKIN applied to wet skin and rinse
▶ Elderly: 15–20 mL/bath, alternatively, to be applied to ▶ Adult: 1–3 capfuls/bath, alternatively, to be applied to
wet skin and rinse wet skin and rinse
DOUBLEBASE ® EMOLLIENT BATH ADDITIVE Pruritus of the elderly
Dry skin conditions including dermatitis and ichthyosis TO THE SKIN
TO THE SKIN ▶ Elderly: 1–3 capfuls/bath, alternatively, to be applied
▶ Child 1 month–11 years: 5–10 mL/bath to wet skin and rinse
▶ Child 12–17 years: 15–20 mL/bath OILATUM ® JUNIOR BATH ADDITIVE
▶ Adult: 15–20 mL/bath Dry skin conditions including dermatitis and ichthyosis
Pruritus of the elderly TO THE SKIN
TO THE SKIN ▶ Child 1 month–11 years: 0.5–2 capfuls/bath, alternatively,
▶ Elderly: 15–20 mL/bath apply to wet skin and rinse continued →
 1002 Dry and scaling skin disorders
▶ Child 12–17 years: 1–3 capfuls/bath, alternatively, apply
to wet skin and rinse
▶ Adult: 1–3 capfuls/bath, alternatively, apply to wet
skin and rinse
Pruritus of the elderly
TO THE SKIN
▶ Elderly: 1–3 capfuls/bath, alternatively, apply to wet
skin and rinse
QV ® BATH OIL
Dry skin conditions including eczema, psoriasis, ichthyosis,
and pruritus
TO THE SKIN
▶ Child 1–11 months: 5 mL/bath, alternatively, to be
applied to wet skin and rinse
▶ Child 1–17 years: 10 mL/bath, alternatively, to be applied
to wet skin and rinse
13 ▶ Adult: 10 mL/bath, alternatively, to be applied to wet
skin and rinse
Skin
QV ® GENTLE WASH
Dry skin conditions including eczema, psoriasis, ichthyosis,
and pruritus
TO THE SKIN
▶ Child: To be used as a soap substitute
▶ Adult: To be used as a soap substitute
ZEROLATUM ®
Dry skin conditions | Dermatitis | Ichthyosis
TO THE SKIN
▶ Child 1 month–11 years: 5–10 mL/bath
▶ Child 12–17 years: 15–20 mL/bath
▶ Adult: 15–20 mL/bath
Pruritus of the elderly
TO THE SKIN
▶ Elderly: 15–20 mL/bath
Important safety information
FIRE HAZARD WITH PARAFFIN-BASED EMOLLIENTS
Emulsifying ointment or 50% Liquid Paraffin and 50%
White Soft Paraffin Ointment in contact with dressings
and clothing is easily ignited by a naked flame. The risk
is greater when these preparations are applied to large
areas of the body, and clothing or dressings become
soaked with the ointment. Patients should be told to
keep away from fire or flames, and not to smoke when
using these preparations. The risk of fire should be
considered when using large quantities of any paraffin-
based emollient.
These preparations make the skin and surfaces
slippery—particular care is needed when bathing.
l DIRECTIONS FOR ADMINISTRATION Emollient bath
additives should be added to bath water; hydration can be
improved by soaking in the bath for 10–20 minutes. Some
bath emollients can be applied to wet skin undiluted and
rinsed off. Emollient preparations contained in tubs
should be removed with a clean spoon or spatula to
reduce bacterial contamination of the emollient.
Emollients should be applied in the direction of hair
growth to reduce the risk of folliculitis.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ EMOLLIENT BATH AND SHOWER PRODUCTS, PARAFFIN-
CONTAINING (Non-proprietary)
Emulsifying wax 90 mg per 1 gram, Liquid paraffin 60 mg per 1
gram, Phenoxyethanol 10 mg per 1 gram, Purified water 690 mg
per 1 gram, White soft paraffin 150 mg per 1 gram Aqueous
BNF 70
cream | 30 gram G £1.29–£1.35 | 100 gram G £2.15 DT price
= £1.00 | 500 gram G £6.35 DT price = £5.00
Gel
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ EMOLLIENT BATH AND SHOWER PRODUCTS, PARAFFIN-
CONTAINING (Non-proprietary)
Liquid paraffin light 700 mg per 1 gram | 150 gram G £5.15
| 150 gram G £5.15
▶ Doublebase (Dermal Laboratories Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram Doublebase emollient wash gel | 200 gram p £5.21
Doublebase emollient shower gel | 200 gram p £5.21
▶ E45 emollient bath (Forum Health Products Ltd)
E45 emollient bath oil | 250 ml (ACBS) £3.19 | 500 ml (ACBS) £5.11
▶ Zerodouble (Thornton & Ross Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram Zerodouble gel | 100 gram £2.25 DT price = £2.65 |
475 gram £4.71
▶ Brands may include Oilatum gel, Oilatum shower gel
Bath additive
EXCIPIENTS: May contain Acetylated lanolin alcohols, cetostearyl
alcohol (including cetyl and stearyl alcohol), fragrances, isopropyl
palmitate
▶ EMOLLIENT BATH AND SHOWER PRODUCTS, PARAFFIN-
CONTAINING (Non-proprietary)
Liquid paraffin light 828 mg per 1 gram | 500 ml G £5.75
Liquid paraffin light 634 mg per 1 ml | 150 ml G £2.82 |
250 ml G £3.25 | 300 ml G £5.10 | 600 ml G £5.89
| 500 ml £3.10
Liquid paraffin light 850.9 mg per 1 gram | 250 ml £2.88 |
500 ml £4.71
Isopropyl myristate 130 mg per 1 ml, Liquid paraffin light
378 mg per 1 ml | 350 ml G £3.88 | 500 ml G £4.42 |
1000 ml G £8.80
▶ Dermalo (Dermal Laboratories Ltd)
Acetylated wool alcohols 50 mg per 1 gram, Liquid paraffin
650 mg per 1 gram Dermalo bath emollient | 500 ml G £3.44
▶ Doublebase emollient bath (Dermal Laboratories Ltd)
Liquid paraffin 650 mg per 1 gram Doublebase emollient bath
additive | 500 ml G £5.45
▶ Zerolatum (Thornton & Ross Ltd)
Acetylated wool alcohols 50 mg per 1 gram, Liquid paraffin
650 mg per 1 gram Zerolatum Emollient bath additive | 500 ml
£4.79
▶ Brands may include Cetraben, Hydromol, LPL , Oilatum, QV
Wash
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates, hydroxybenzoates (parabens)
▶ EMOLLIENT BATH AND SHOWER PRODUCTS, PARAFFIN-
CONTAINING (Non-proprietary)
| 250 gram £2.99 | 250 ml £3.14 | 500 ml £5.24
▶ E45 emollient wash (Forum Health Products Ltd)
E45 emollient wash cream | 250 ml (ACBS) £3.19
▶ Brands may include Aquamax wash, QV Gentle wash
Emollient bath and shower products,
soya-bean oil-containing
INDICATIONS AND DOSE
BALNEUM ® BATH OIL
Dry skin conditions including those associated with
dermatitis and eczema
TO THE SKIN
▶ Child 1–23 months: 5–15 mL/bath, not to be used
undiluted
▶ Adult: 20–60 mL/bath, not to be used undiluted
BALNEUM ® PLUS BATH OIL
Dry skin conditions including those associated with
dermatitis and eczema where pruritus also experienced
TO THE SKIN
▶ Child 1–23 months: 5 mL/bath, alternatively, to be
applied to wet skin and rinse
 BNF 70
▶ Adult: 20 mL/bath, alternatively, to be applied to wet
skin and rinse
ZERONEUM ®
Dry skin conditions including eczema
TO THE SKIN
▶ Child 1 month–11 years: 5 mL/bath
▶ Child 12–17 years: 20 mL/bath
▶ Adult: 20 mL/bath
Important safety information
These preparations make skin and surfaces slippery—
particular care is needed when bathing.
l DIRECTIONS FOR ADMINISTRATION Emollient bath
additives should be added to bath water; hydration can be
improved by soaking in the bath for 10–20 minutes. Some
bath emollients can be applied to wet skin undiluted and
rinsed off. Emollient preparations contained in tubs
should be removed with a clean spoon or spatula to
reduce bacterial contamination of the emollient.
Emollients should be applied in the direction of hair
growth to reduce the risk of folliculitis.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Bath additive
EXCIPIENTS: May contain Butylated hydroxytoluene, fragrances,
propylene glycol
▶ EMOLLIENT BATH AND SHOWER PRODUCTS, SOYA-BEAN OIL-
CONTAINING (Non-proprietary)
Lauromacrogols 150 mg per 1 gram, Soya oil 829.5 mg per 1
gram | 500 ml G £6.66
Soya oil 847.5 mg per 1 gram | 200 ml G £2.48 |
500 ml G £5.38 | 1000 ml G £10.39
▶ Zeroneum (Thornton & Ross Ltd)
Soya oil 833.5 mg per 1 gram Zeroneum 83.35% bath additive |
500 ml £4.48
▶ Brands may include Balneum
Emollient bath and shower products,
tar-containing
INDICATIONS AND DOSE
POLYTAR EMOLLIENT ®
Psoriasis, eczema, atopic and pruritic dermatoses
TO THE SKIN
▶ Adult: 2–4 capfuls/bath, add 15–30 mL to an adult-size
bath and proportionally less for a child’s bath; soak for
20 minutes
PSORIDERM ® EMULSION
Psoriasis
TO THE SKIN
▶ Adult: Up to 30 mL/bath, use 30mL in adult-size bath,
and proportionately less for a child’s bath, soak for 5
minutes
Important safety information
These preparations make skin and surfaces slippery—
particular care is needed when bathing.
DIRECTIONS FOR ADMINISTRATION Emollient bath
l
additives should be added to bath water; hydration can be
improved by soaking in the bath for 10–20 minutes. Some
bath emollients can be applied to wet skin undiluted and
rinsed off. Emollient preparations contained in tubs
should be removed with a clean spoon or spatula to
reduce bacterial contamination of the emollient.
Dry and scaling skin disorders 1003
Emollients should be applied in the direction of hair
growth to reduce the risk of folliculitis.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Bath additive
EXCIPIENTS: May contain Isopropyl palmitate, polysorbates
▶ EMOLLIENT BATH AND SHOWER PRODUCTS, TAR-CONTAINING
(Non-proprietary)
Coal tar distilled 400 mg per 1 ml | 200 ml p £2.74
▶ Polytar (GlaxoSmithKline Consumer Healthcare)
Arachis oil extract of crude coal tar 75 mg per 1 gram, Cade oil
75 mg per 1 gram, Coal tar solution 25 mg per 1 gram, Liquid
paraffin light 350 mg per 1 gram, Pine tar 75 mg per 1
gram Polytar Emollient | 500 ml G £5.78
▶ Brands may include Psoriderm Emulsion 40% bath additive
13
Emollient creams and ointments,
Skin
antimicrobial-containing
INDICATIONS AND DOSE
Dry and pruritic skin conditions including eczema and
dermatitis
TO THE SKIN
▶ Child: To be applied to the skin or used as a soap
substitute
▶ Adult: To be applied to the skin or used as a soap
substitute
l DIRECTIONS FOR ADMINISTRATION Emollients should be
applied immediately after washing or bathing to maximise
the effect of skin hydration. Emollient preparations
contained in tubs should be removed with a clean spoon
or spatula to reduce bacterial contamination of the
emollient. Emollients should be applied in the direction of
hair growth to reduce the risk of folliculitis.
l PRESCRIBING AND DISPENSING INFORMATION
Preparations containing an antibacterial should be
avoided unless infection is present or is a frequent
complication.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ Dermol 500 (Dermal Laboratories Ltd)
Benzalkonium chloride 1 mg per 1 gram, Chlorhexidine
hydrochloride 1 mg per 1 gram, Isopropyl myristate 25 mg per 1
gram, Liquid paraffin 25 mg per 1 gram Dermol 500 lotion |
500 ml p £6.04
Cream
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ Dermol (Dermal Laboratories Ltd)
Benzalkonium chloride 1 mg per 1 gram, Chlorhexidine
hydrochloride 1 mg per 1 gram, Isopropyl myristate 100 mg per
1 gram, Liquid paraffin 100 mg per 1 gram Dermol cream |
100 gram p £2.86 | 500 gram p £6.63
Emollient creams and ointments,
colloidal oatmeal-containing
INDICATIONS AND DOSE
Endogenous and exogenous eczema | Xeroderma | Ichthyosis
TO THE SKIN
▶ Child: (consult product literature)
▶ Adult: (consult product literature) continued →
 1004 Dry and scaling skin disorders
Senile pruritus (pruritus of the elderly) associated with dry
skin
TO THE SKIN
▶ Elderly: (consult product literature)
l DIRECTIONS FOR ADMINISTRATION Emollients should be
applied immediately after washing or bathing to maximise
the effect of skin hydration. Emollient preparations
contained in tubs should be removed with a clean spoon
or spatula to reduce bacterial contamination of the
emollient. Emollients should be applied in the direction of
hair growth to reduce the risk of folliculitis.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream and lotion
13 EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), isopropyl palmitate
▶ EMOLLIENT CREAMS AND OINTMENTS, COLLOIDAL OATMEAL-
Skin
CONTAINING (Non-proprietary) | 500 ml (ACBS) £6.66 | 100 ml
(ACBS) £3.97 | 300 ml (ACBS) £6.80
▶ Brands may include Aveeno
Emollient creams and ointments,
paraffin-containing
INDICATIONS AND DOSE
Dry skin conditions | Eczema | Psoriasis | Ichthyosis | Pruritus
TO THE SKIN
▶ Adult: (consult product literature)
Important safety information
FIRE HAZARD WITH PARAFFIN-BASED EMOLLIENTS
Emulsifying ointment or 50% Liquid Paraffin and 50%
White Soft Paraffin Ointment in contact with dressings
and clothing is easily ignited by a naked flame. The risk
is greater when these preparations are applied to large
areas of the body, and clothing or dressings become
soaked with the ointment. Patients should be told to
keep away from fire or flames, and not to smoke when
using these preparations. The risk of fire should be
considered when using large quantities of any paraffin-
based emollient.
l DIRECTIONS FOR ADMINISTRATION Emollients should be
applied immediately after washing or bathing to maximise
the effect of skin hydration. Emollient preparations
contained in tubs should be removed with a clean spoon
or spatula to reduce bacterial contamination of the
emollient. Emollients should be applied in the direction of
hair growth to reduce the risk of folliculitis.
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Paraffin,
Yellow Soft, BP consists of yellow petroleum jelly.
Paraffin White Soft, BP consists of white petroleum jelly.
Emulsifying ointment, BP consists of emulsifying wax
30%, white soft paraffin 50% and liquid paraffin 20%.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), hydroxybenzoates (parabens), isopropyl
palmitate
▶ EMOLLIENT CREAMS AND OINTMENTS, PARAFFIN-CONTAINING
(Non-proprietary)
White soft paraffin 50 mg per 1 gram QV 5% skin lotion | 250 ml
£3.14 | 500 ml £5.24
▶ E45 (Forum Health Products Ltd)
E45 lotion | 200 ml £2.40 | 500 ml £4.50
BNF 70
▶ Brands may include QV
Cream
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), chlorocresol, disodium edetate, fragrances,
hydroxybenzoates (parabens), polysorbates, propylene glycol, sorbic
acid, lanolin
▶ EMOLLIENT CREAMS AND OINTMENTS, PARAFFIN-CONTAINING
(Non-proprietary)
Isopropyl myristate 50 mg per 1 gram, Liquid paraffin 100 mg
per 1 gram, Sodium lactate 10 mg per 1 gram, Sodium pidolate
25 mg per 1 gram | 50 gram G £2.19 | 100 gram G £4.09 |
500 gram G £11.92
Glycerol 100 mg per 1 gram, Liquid paraffin light 100 mg per 1
gram, White soft paraffin 50 mg per 1 gram | 100 gram £2.04 |
500 gram £5.86 | 1050 gram £11.94
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram | 50 gram £1.40 | 150 gram £3.98 |
500 gram £5.99 | 1050 gram £11.62
Liquid paraffin 126 mg per 1 gram, White soft paraffin 145 mg
per 1 gram | 50 gram £1.17 | 500 gram £4.08
Liquid paraffin light 60 mg per 1 gram, White soft paraffin
150 mg per 1 gram | 50 gram G £1.63 | 150 gram G
£2.46 | 500 ml G £4.99 | 1050 ml G £9.98
▶ Aquamol (Thornton & Ross Ltd)
Aquamol cream | 50 gram £1.22 | 500 gram £6.40
▶ E45 (Forum Health Products Ltd)
Liquid paraffin light 126 mg per 1 gram, White soft paraffin
145 mg per 1 gram, Wool fat 10 mg per 1 gram E45 cream |
50 gram G £1.61 | 125 gram G £2.90 | 350 gram G
£5.17 | 500 gram G £5.62
▶ Enopen (Ennogen Healthcare Ltd)
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram Enopen cream | 500 gram £5.99
▶ Epaderm (Molnlycke Health Care Ltd)
Epaderm cream | 50 gram £1.70 | 500 gram £6.95
▶ Lipobase (Astellas Pharma Ltd)
Lipobase cream | 50 gram p £1.46
▶ Soffen (Vitame Ltd)
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram Soffen cream | 500 gram £4.79
▶ Unguentum M (Almirall Ltd)
Unguentum M cream | 50 gram G £1.41 | 60 gram G no price
available | 100 gram G £2.78 | 200 ml G £5.50 |
500 gram G £8.48
▶ ZeroAQS (Thornton & Ross Ltd)
ZeroAQS emollient cream | 500 gram £3.29
▶ Zerobase (Thornton & Ross Ltd)
Liquid paraffin 110 mg per 1 gram Zerobase 11% cream |
50 gram £1.04 | 500 gram £5.26
▶ Zeroguent (Thornton & Ross Ltd)
Liquid paraffin light 80 mg per 1 gram, Soya oil 50 mg per 1
gram, White soft paraffin 40 mg per 1 gram Zeroguent cream |
100 gram £2.33 | 500 gram £6.99
▶ Brands may include Aquamax, Cetraben, Diprobase, Hydromol,
Oilatum , QV, Ultrabase, Zerocream
Gel
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ Doublebase (Dermal Laboratories Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram Doublebase Dayleve gel | 100 gram p £2.65 DT price =
£2.65 | 500 gram p £6.29 DT price = £5.83
Doublebase gel | 100 gram p £2.65 DT price = £2.65 | 500 gram p
£5.83 DT price = £5.83
Ointment
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates
▶ EMOLLIENT CREAMS AND OINTMENTS, PARAFFIN-CONTAINING
(Non-proprietary)
Yellow soft paraffin 1 mg per 1 mg Yellow soft paraffin solid |
15 gram G £0.85–£1.11 | 500 gram G £10.18 DT price =
£10.18 | 4500 gram G £18.29
Magnesium sulfate dried 5 mg per 1 gram, Phenoxyethanol
10 mg per 1 gram, Wool alcohols ointment 500 mg per 1
gram | 500 gram G £5.80 DT price = £4.89
White soft paraffin 1 mg per 1 mg White soft paraffin solid |
500 gram G £4.18 DT price = £3.23 | 4500 gram G £18.62–
£29.07
 BNF 70 Dry and scaling skin disorders 1005

Emulsifying wax 300 mg per 1 gram, Yellow soft paraffin 300 mg E45 ® ITCH RELIEF CREAM
per 1 gram | 125 gram £2.88 | 500 gram £4.89 | 1000 gram £9.09 Dry, scaling, and itching skin
Liquid paraffin 500 mg per 1 gram, White soft paraffin 500 mg
TO THE SKIN
per 1 gram White soft paraffin 50% / Liquid paraffin 50%
ointment | 250 gram £1.87 | 500 gram £6.80 DT price = £4.57 | ▶ Child: Apply twice daily
500 gram p £4.57 DT price = £4.57 ▶ Adult: Apply twice daily
Emulsifying wax 300 mg per 1 gram, Liquid paraffin 200 mg per EUCERIN ® INTENSIVE CREAM
1 gram, White soft paraffin 500 mg per 1 gram Emulsifying Dry skin conditions including eczema, ichthyosis,
ointment | 100 gram G no price available | 500 gram P no
price available DT price = £2.43
xeroderma, and hyperkeratosis
Liquid paraffin 50 mg per 1 gram, White soft paraffin 950 mg TO THE SKIN
per 1 gram | 50 gram G £1.28 | 500 gram G £5.99 ▶ Child: Apply twice daily, to be applied thinly and
▶ Epaderm (Molnlycke Health Care Ltd) rubbed into area
Emulsifying wax 300 mg per 1 gram, Yellow soft paraffin 300 mg ▶ Adult: Apply twice daily, to be applied thinly and
per 1 gram Epaderm ointment | 125 gram £3.85 | 500 gram rubbed into area
£6.53 | 1000 gram £12.02 EUCERIN ® INTENSIVE LOTION
▶ Brands may include Diprobase ointment, Hydromol ointment, Hydrous
ointment, QV Intensive, Zeroderm Dry skin conditions including eczema, ichthyosis, xeroderma
Spray and hyperkeratosis
CAUTIONARY AND ADVISORY LABELS 15 TO THE SKIN 13
▶ Dermamist (Alliance Pharmaceuticals Ltd) ▶ Child: Apply twice daily, to be applied sparingly and

Skin
White soft paraffin 100 mg per 1 gram Dermamist 10% spray | rubbed into area
250 ml p £5.97 ▶ Adult: Apply twice daily, to be applied sparingly and
▶ Emollin (C D Medical Ltd) rubbed into area
Emollin aerosol spray | 150 ml £4.00 | 240 ml £6.39
FLEXITOL ®
Dry skin on soles of feet and heels
Emollients, urea-containing TO THE SKIN
▶ Child 12–17 years: Apply 1–2 times a day
l DRUG ACTION Urea is a keratin softener and hydrating ▶ Adult: Apply 1–2 times a day
agent used in the treatment of dry, scaling conditions HYDROMOL ® INTENSIVE
(including ichthyosis) and may be useful in elderly Dry, scaling and itching skin
patients.
TO THE SKIN
INDICATIONS AND DOSE ▶ Child: Apply twice daily, to be applied thinly
AQUADRATE ®
▶ Adult: Apply twice daily, to be applied thinly
NUTRAPLUS ®
Dry, scaling and itching skin
TO THE SKIN Dry, scaling and itching skin
▶ Child: Apply twice daily, to be applied thinly TO THE SKIN
▶ Adult: Apply twice daily, to be applied thinly ▶ Child: Apply 2–3 times a day
BALNEUM ® CREAM
▶ Adult: Apply 2–3 times a day
Dry skin conditions l DIRECTIONS FOR ADMINISTRATION Emollients should be
TO THE SKIN applied immediately after washing or bathing to maximise
▶ Child: Apply twice daily the effect of skin hydration. Emollient preparations
▶ Adult: Apply twice daily contained in tubs should be removed with a clean spoon
BALNEUM ® PLUS CREAM or spatula to reduce bacterial contamination of the
Dry, scaling and itching skin emollient. Emollients should be applied in the direction of
TO THE SKIN hair growth to reduce the risk of folliculitis.
▶ Child: Apply twice daily
l MEDICINAL FORMS
▶ Adult: Apply twice daily There can be variation in the licensing of different medicines
CALMURID ® containing the same drug.
Dry, scaling and itching skin Liquid
TO THE SKIN EXCIPIENTS: May contain Benzyl alcohol, isopropyl palmitate
▶ Child: Apply twice daily, apply a thick layer for ▶ Eucerin (Beiersdorf UK Ltd)
Urea 100 mg per 1 gram Eucerin Intensive 10% lotion |
3–5 minutes, massage into area, and remove excess. 250 ml G £7.93
Can be diluted with aqueous cream (life of diluted
Cream
cream is 14 days). Half-strength cream can be used for EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
1 week if stinging occurs cetyl and stearyl alcohol), hydroxybenzoates (parabens), isopropyl
▶ Adult: Apply twice daily, apply a thick layer for palmitate, polysorbates, propylene glycol, wool fat and related
3–5 minutes, massage into area, and remove excess. substances including lanolin
Can be diluted with aqueous cream (life of diluted ▶ EMOLLIENTS, UREA-CONTAINING (Non-proprietary)
cream is 14 days). Half-strength cream can be used for Lauromacrogols 30 mg per 1 gram, Urea 50 mg per 1 gram |
1 week if stinging occurs 100 gram G £3.29 | 500 gram G £14.99
Urea 100 mg per 1 gram Urea 10% cream | 50 gram £2.85 |
DERMATONICS ONCE HEEL BALM ® 500 gram £9.97
Dry skin on soles of feet ▶ Aquadrate (Alliance Pharmaceuticals Ltd)
TO THE SKIN Urea 100 mg per 1 gram Aquadrate 10% cream | 100 gram p
▶ Child 12–17 years: Apply daily £4.37
▶ Adult: Apply daily ▶ Calmurid (Galderma (UK) Ltd)
Lactic acid 50 mg per 1 gram, Urea 100 mg per 1 gram Calmurid
cream | 100 gram p £9.27 DT price = £9.27 | 500 gram p £35.70
DT price = £35.70
 1006 Infections of the skin
▶ E45 Itch Relief (Forum Health Products Ltd)
Lauromacrogols 30 mg per 1 gram, Urea 50 mg per 1 gram E45
Itch Relief cream | 50 gram G £2.81 | 100 gram G £3.74 |
500 gram G £14.99
▶ Hydromol Intensive (Alliance Pharmaceuticals Ltd)
Urea 100 mg per 1 gram Hydromol Intensive 10% cream |
30 gram p £1.64 | 100 gram p £4.37
▶ Nutraplus (Galderma (UK) Ltd)
Urea 100 mg per 1 gram Nutraplus 10% cream | 100 gram p
£4.37
▶ Brands may include Balneum cream, Balneum Plus cream
Balms
EXCIPIENTS: May contain Beeswax, benzyl alcohol, cetostearyl alcohol
(including cetyl and stearyl alcohol), fragrances, lanolin
▶ EMOLLIENTS, UREA-CONTAINING (Non-proprietary)
75 ml £3.60 | 200 ml £8.50
▶ Flexitol (Thornton & Ross Ltd)
Flexitol Heel Balm | 40 gram £2.75 | 56 gram no price available |
75 gram £3.80 | 112 gram no price available | 200 gram £9.40 |
13 500 gram £14.75
▶ Brands may include Dermatonics Once Heel Balm
Skin
2 Infections of the skin
Skin infections
Antibacterial preparations
Cellulitis, a rapidly spreading deeply seated inflammation of
the skin and subcutaneous tissue, requires systemic
antibacterial treatment. Lower leg infections or infections
spreading around wounds are almost always cellulitis.
Erysipelas, a superficial infection with clearly defined edges
(and often affecting the face), is also treated with a systemic
antibacterial.
In the community, acute impetigo on small areas of the
skin may be treated by short-term topical application of
fusidic acid p. 1008; mupirocin p. 1009 should be used only
to treat meticillin-resistant Staphylococcus aureus. If the
impetigo is extensive or longstanding, an oral antibacterial
such as flucloxacillin p. 486 (or clarithromycin p. 470 in
penicillin allergy) should be used. Mild antiseptics can be
used to soften crusts.
Although many antibacterial drugs are available in topical
preparations, some are potentially hazardous and frequently
their use is not necessary if adequate hygienic measures can
be taken. Moreover, not all skin conditions that are oozing,
crusted, or characterised by pustules are actually infected.
Topical antibacterials should be avoided on leg ulcers unless
used in short courses for defined infections; treatment of
bacterial colonisation is generally inappropriate.
To minimise the development of resistant organisms it is
advisable to limit the choice of antibacterials applied
topically to those not used systemically. Unfortunately
some of these, for example neomycin sulfate p. 1009, may
cause sensitisation, and there is cross-sensitivity with other
aminoglycoside antibiotics, such as gentamicin p. 450. If
large areas of skin are being treated, ototoxicity may also be
a hazard with aminoglycoside antibiotics (and also with
polymyxins), particularly in children, in the elderly, and in
those with renal impairment. Resistant organisms are more
common in hospitals, and whenever possible swabs should
be taken for bacteriological examination before beginning
treatment.
Mupirocin p. 1009 is not related to any other antibacterial
in use; it is effective for skin infections, particularly those
due to Gram-positive organisms but it is not indicated for
pseudomonal infection. Although Staphylococcus aureus
strains with low-level resistance to mupirocin are emerging,
it is generally useful in infections resistant to other
antibacterials. To avoid the development of resistance,
mupirocin or fusidic acid p. 1008 should not be used for
BNF 70
longer than 10 days and local microbiology advice should be
sought before using it in hospital. In the presence of
mupirocin-resistant MRSA infection, a topical antiseptic
such as povidone-iodine p. 1053, chlorhexidine p. 1051
p. 989, or alcohol can be used; their use should be discussed
with the local microbiologist.
Retapamulin p. 1009 can be used for impetigo and other
superficial bacterial skin infections caused by Staphylococcus
aureus and Streptococcus pyogenes that are resistant to first-
line topical antibacterials. However, it is not effective
against MRSA.
Silver sulfadiazine p. 1010 is used in the treatment of
infected burns.
Antibacterial preparations also used systemically
Fusidic acid p. 1008 is a narrow-spectrum antibacterial used
for staphylococcal infections. Fusidic acid has a role in the
treatment of impetigo.
An ointment containing fusidic acid is used in the fissures
of angular cheilitis when associated with staphylococcal
infection. See Oropharyx infections, fungal p. 996 for
further information on angular cheilitis.
Metronidazole p. 1008 is used topically for rosacea and to
reduce the odour associated with anaerobic infections; oral
metronidazole is used to treat wounds infected with
anaerobic bacteria.
Antifungal preparations
Most localised fungal infections are treated with topical
preparations. To prevent relapse, local antifungal treatment
should be continued for 1–2 weeks after the disappearance
of all signs of infection. Systemic therapy is necessary for
scalp infection or if the skin infection is widespread,
disseminated, or intractable; although topical therapy may
be used to treat some nail infections, systemic therapy is
more effective. Skin scrapings should be examined if
systemic therapy is being considered or where there is
doubt about the diagnosis.
Dermatophytoses
Ringworm infection can affect the scalp (tinea capitis), body
(tinea corporis), groin (tinea cruris), hand (tinea manuum),
foot (tinea pedis, athlete’s foot), or nail (tinea unguium).
Scalp infection requires systemic treatment; additional
application of a topical antifungal, during the early stages of
treatment, may reduce the risk of transmission. A topical
antifungal can also be used to treat asymptomatic carriers
of scalp ringworm. Most other local ringworm infections can
be treated adequately with topical antifungal preparations
(including shampoos). The imidazole antifungals
clotrimazole p. 1010, econazole nitrate p. 1011,
ketoconazole p. 1011, and miconazole p. 1011 are all
effective. Terbinafine p. 1013 cream is also effective but it is
more expensive. Other topical antifungals include
griseofulvin p. 1012 and the undecenoates. Compound
benzoic acid ointment (Whitfield’s ointment) has been
used for ringworm infections but it is cosmetically less
acceptable than proprietary preparations. Topical
preparations for athlete’s foot containing tolnaftate are on
sale to the public.
Antifungal dusting powders are of little therapeutic value
in the treatment of fungal skin infections and may cause
skin irritation; they may have some role in preventing re-
infection.
Antifungal treatment may not be necessary in
asymptomatic patients with tinea infection of the nails. If
treatment is necessary, a systemic antifungal is more
effective than topical therapy. However, topical application
of amorolfine p. 1012 or tioconazole p. 1012 may be useful
for treating early onychomycosis when involvement is
limited to mild distal disease, or for superficial white
onychomycosis, or where there are contra-indications to
systemic therapy.
 BNF 70
Pityriasis versicolor
Pityriasis (tinea) versicolor can be treated with ketoconazole
shampoo p. 1011. Alternatively, selenium sulfide shampoo
[unlicensed indication] can be used as a lotion (diluting with
a small amount of water can reduce irritation) and left on
the affected area for 10 minutes before rinsing off; it should
be applied once daily for 7 days, and the course repeated if
necessary.
Topical imidazole antifungals such as clotrimazole
p. 1010, econazole nitrate p. 1011, ketoconazole p. 1011,
and miconazole p. 997, or topical terbinafine p. 514 are
alternatives, but large quantities may be required.
If topical therapy fails, or if the infection is widespread,
pityriasis versicolor is treated systemically with a triazole
antifungal. Relapse is common, especially in the
immunocompromised.
Candidiasis
Candidal skin infections can be treated with a topical
imidazole antifungal, such as clotrimazole p. 1010,
econazole nitrate p. 1011, ketoconazole p. 1011, or
miconazole p. 1011; topical terbinafine p. 1013 is an
alternative. Topical application of nystatin p. 997 is also
effective for candidiasis but it is ineffective against
dermatophytosis. Refractory candidiasis requires systemic
treatment generally with a triazole such as fluconazole
p. 518; systemic treatment with terbinafine is not
appropriate for refractory candidiasis.
Angular cheilitis
Miconazole p. 1011 cream is used in the fissures of angular
cheilitis when associated with Candida.
Compound topical preparations
Combination of an imidazole and a mild corticosteroid
(such as hydrocortisone 1% p. 993) may be of value in the
treatment of eczematous intertrigo and, in the first few days
only, of a severely inflamed patch of ringworm.
Combination of a mild corticosteroid with either an
imidazole or nystatin p. 997 may be of use in the treatment
of intertrigo associated with candida.
Antiviral preparations
Aciclovir cream p. 1016 is licensed for the treatment of
initial and recurrent labial and genital herpes simplex
infections; treatment should begin as early as possible.
Systemic treatment is necessary for buccal or vaginal
infections and for herpes zoster (shingles).
Herpes labialis
Aciclovir cream can be used for the treatment of initial and
recurrent labial herpes simplex infections (cold sores). It is
best applied at the earliest possible stage, usually when
prodromal changes of sensation are felt in the lip and before
vesicles appear.
Penciclovir cream is also licensed for the treatment of
herpes labialis; it needs to be applied more frequently than
aciclovir cream.
Systemic treatment is necessary if cold sores recur
frequently or for infections in the mouth.
Parasiticidal preparations
Suitable quantities of parasiticidal
preparations
Area of body Skin creams Lotions Cream rinses
Scalp (head lice) 50–100 mL 50–100 mL
Body (scabies) 30–60 g 100 mL
Body (crab lice) 30–60 g 100 mL
These amounts are usually suitable for an adult for single application.
Infections of the skin 1007
Scabies
Permethrin p. 1015 is used for the treatment of scabies
(Sarcoptes scabiei); malathion p. 1015 can be used if
permethrin is inappropriate.
Benzyl benzoate p. 1014 is an irritant and should be
avoided in children; it is less effective than malathion and
permethrin.
Ivermectin p. 1015 (available on a named patient basis
from ‘special-order’ manufacturers or specialist importing
companies) by mouth has been used, in combination with
topical drugs, for the treatment of hyperkeratotic (crusted
or ‘Norwegian’) scabies that does not respond to topical
treatment alone; further doses may be required.
Application
Although acaricides have traditionally been applied after a
hot bath, this is not necessary and there is even evidence
that a hot bath may increase absorption into the blood,
removing them from their site of action on the skin.
13
All members of the affected household should be treated
Skin
simultaneously. Treatment should be applied to the whole
body including the scalp, neck, face, and ears. Particular
attention should be paid to the webs of the fingers and toes
and lotion brushed under the ends of nails. It is now
recommended that malathion and permethrin should be
applied twice, one week apart; in the case of benzyl
benzoate in adults, up to 3 applications on consecutive days
may be needed. It is important to warn users to reapply
treatment to the hands if they are washed. Patients with
hyperkeratotic scabies may require 2 or 3 applications of
acaricide on consecutive days to ensure that enough
penetrates the skin crusts to kill all the mites.
Itching
The itch and eczema of scabies persists for some weeks after
the infestation has been eliminated and treatment for
pruritus and eczema may be required. Application of
crotamiton p. 1040 can be used to control itching after
treatment with more effective acaricides. A topical
corticosteroid may help to reduce itch and inflammation
after scabies has been treated successfully; however,
persistent symptoms suggest that scabies eradication was
not successful. Oral administration of a sedating
antihistamine at night may also be useful.
Head lice
Dimeticone p. 1014 is effective against head lice (Pediculus
humanus capitis). It coats head lice and interferes with water
balance in lice by preventing the excretion of water; it is
less active against eggs and treatment should be repeated
after 7 days. Malathion p. 1015, an organophosphorus
insecticide, is an alternative, but resistance has been
reported. Benzyl benzoate p. 1014 is licensed for the
treatment of head lice but it is less effective than other
drugs and not recommended for use in children. Permethrin
is active against head lice but the formulation and licensed
methods of application of the current products make them
unsuitable for the treatment of head lice.
Head lice infestation (pediculosis) should be treated using
lotion or liquid formulations only if live lice are present.
Shampoos are diluted too much in use to be effective. A
contact time of 8–12 hours or overnight treatment is
recommended for lotions and liquids; a 2-hour treatment is
not sufficient to kill eggs.
In general, a course of treatment for head lice should be 2
applications of product 7 days apart to kill lice emerging
from any eggs that survive the first application. All affected
household members should be treated simultaneously.
Wet combing methods
Head lice can be mechanically removed by combing wet hair
meticulously with a plastic detection comb (probably for at
least 30 minutes each time) over the whole scalp at 4-day
intervals for a minimum of 2 weeks, and continued until no
 1008 Infections of the skin BNF 70

lice are found on 3 consecutive sessions; hair conditioner or CAUTIONS, FURTHER INFORMATION
vegetable oil can be used to facilitate the process. Avoiding resistance To avoid the development of
Several devices for the removal of head lice such as combs resistance, fusidic acid should not be used for longer than
and topical solutions, are available and some are 10 days and local microbiology advice should be sought
prescribable on the NHS. before using it in hospital.
The Drug Tariffs can be accessed online at: l SIDE-EFFECTS
. National Health Service Drug Tariff for England and ▶ Rare Hypersensitivity reactions
Wales: www.ppa.org.uk/ppa/edt_intro.htm l PROFESSION SPECIFIC INFORMATION
. Health and Personal Social Services for Northern
Ireland Drug Tariff: www.dhsspsni.gov.uk/pas-tariff Dental practitioners’ formulary
. Scottish Drug Tariff: www.isdscotland.org/Health-topics/ May be prescribed as Sodium Fusidate ointment.
Prescribing-and-Medicines/Scottish-Drug-Tariff/ l MEDICINAL FORMS
Crab lice There can be variation in the licensing of different medicines
Permethrin p. 1015 and malathion p. 1015 are used to containing the same drug.
eliminate crab lice (Pthirus pubis). An aqueous preparation Cream
EXCIPIENTS: May contain Butylated hydroxyanisole, cetostearyl alcohol
should be applied, allowed to dry naturally and washed off
(including cetyl and stearyl alcohol)
after 12 hours; a second treatment is needed after 7 days to
13 kill lice emerging from surviving eggs. All surfaces of the
▶ FUSIDIC ACID (Non-proprietary)
Fusidic acid 20 mg per 1 gram Fusidic acid 2% cream |
body should be treated, including the scalp, neck, and face 15 gram P £1.92 DT price = £1.92 | 30 gram P £3.59 DT price
Skin

(paying particular attention to the eyebrows and other facial = £3.59

hair). A different insecticide should be used if a course of ▶ Fucidin (Fusidic acid) (LEO Pharma)
treatment fails. Fusidic acid 20 mg per 1 gram Fucidin 2% cream | 15 gram P
£1.92 DT price = £1.92 | 30 gram P £3.59 DT price = £3.59
Ointment
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
2.1 Bacterial skin infections stearyl alcohol), wool fat and related substances including lanolin
▶ Fucidin (Sodium fusidate) (LEO Pharma)
Sodium fusidate 20 mg per 1 gram Fucidin 2% ointment |
15 gram P £2.23 DT price = £2.23 | 30 gram P £3.79 DT price
= £3.79

Bacitracin with polymyxin B

INDICATIONS AND DOSE Metronidazole
Bacterial skin infections l DRUG ACTION Metronidazole is an antimicrobial drug
TO THE SKIN with high activity against anaerobic bacteria and
▶ Child: Apply twice daily, can be applied more protozoa.
frequently if required
▶ Adult: Apply twice daily, can be applied more INDICATIONS AND DOSE
frequently if required ACEA ®
Acute inflammatory exacerbation of rosacea
l CAUTIONS Nephrotoxicity . neurotoxicity TO THE SKIN
CAUTIONS, FURTHER INFORMATION ▶ Adult: Apply twice daily for 8 weeks, to be applied
If large areas of skin are being treated nephrotoxicity and thinly
neurotoxicity may be a hazard, particularly in children ANABACT ®
with renal impairment. Malodorous fungating tumours and malodorous
l SIDE-EFFECTS gravitational and decubitus ulcers
▶ Frequency not known Contact sensitisation TO THE SKIN
l RENAL IMPAIRMENT Renal impairment increases the risk ▶ Adult: Apply 1–2 times a day, to be applied to clean
of nephrotoxicity and neurotoxicity. wound and covered with non-adherent dressing
METROGEL ®
l MEDICINAL FORMS
There can be variation in the licensing of different medicines Acute inflammatory exacerbation of rosacea
containing the same drug. TO THE SKIN
Ointment ▶Adult: Apply twice daily for 8–9 weeks, to be applied
▶ Polyfax (Teva UK Ltd) thinly
Bacitracin zinc 500 unit per 1 gram, Polymyxin B sulfate 10000 Malodorous fungating tumours
unit per 1 gram Polyfax ointment | 4 gram P £3.26 |
TO THE SKIN
20 gram P £4.62 DT price = £4.62
▶ Adult: Apply 1–2 times a day, to be applied to clean
wound and covered with non-adherent dressing
METROSA ®
Fusidic acid Acute exacerbation of rosacea
l DRUG ACTION Fusidic acid and its salts are narrow- TO THE SKIN
spectrum antibiotics used for staphylococcal infections. ▶ Adult: Apply twice daily for up to 8 weeks, to be
applied thinly
INDICATIONS AND DOSE
ROSICED ®
Staphylococcal skin infection
TO THE SKIN Inflammatory papules and pustules of rosacea
▶ Child: Apply 3–4 times a day usually for 7 days TO THE SKIN
▶ Adult: Apply 3–4 times a day ▶ Adult: Apply twice daily for 6 weeks (longer if
necessary)
l CAUTIONS Avoid contact of cream or ointment with eyes
 BNF 70
ROZEX ® PREPARATIONS
Inflammatory papules, pustules and erythema of rosacea
TO THE SKIN
▶ Adult: Apply twice daily for 3–4 months
ZYOMET ®
Acute inflammatory exacerbation of rosacea
TO THE SKIN
▶ Adult: Apply twice daily for 8–9 weeks, to be applied
thinly
l CAUTIONS Avoid exposure to strong sunlight or UV light
l SIDE-EFFECTS Skin irritation
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include:gel, cream
Cream
EXCIPIENTS: May contain Benzyl alcohol, isopropyl palmitate,
propylene glycol
▶ Rosiced (Pierre Fabre Dermo-Cosmetique)
Metronidazole 7.5 mg per 1 gram Rosiced 0.75% cream |
30 gram P £7.50 DT price = £6.60
▶ Rozex (Galderma (UK) Ltd)
Metronidazole 7.5 mg per 1 gram Rozex 0.75% cream |
30 gram P £6.60 DT price = £6.60 | 40 gram P £9.88 DT price
= £9.88
Gel
EXCIPIENTS: May contain Benzyl alcohol, disodium edetate,
hydroxybenzoates (parabens), propylene glycol
▶ METRONIDAZOLE (Non-proprietary)
Metronidazole 7.5 mg per 1 gram Metronidazole 0.75% gel |
15 gram P no price available | 30 gram P £12.00 |
40 gram P £19.90
▶ Acea (Ferndale Pharmaceuticals Ltd)
Metronidazole 7.5 mg per 1 gram Acea 0.75% gel | 40 gram
£9.95
▶ Anabact (Cambridge Healthcare Supplies Ltd)
Metronidazole 7.5 mg per 1 gram Anabact 0.75% gel |
15 gram P £4.47 | 30 gram P £7.89
▶ Metrogel (Galderma (UK) Ltd)
Metronidazole 7.5 mg per 1 gram Metrogel 0.75% gel |
40 gram P £22.63
▶ Metrosa (Linderma Ltd)
Metronidazole 7.5 mg per 1 gram Metrosa 0.75% gel |
30 gram P £12.00 | 40 gram P £19.90
▶ Rozex (Galderma (UK) Ltd)
Metronidazole 7.5 mg per 1 gram Rozex 0.75% gel |
30 gram P £6.60 | 40 gram P £9.88
▶ Zyomet (AMCo)
Metronidazole 7.5 mg per 1 gram Zyomet 0.75% gel |
30 gram P £12.00
Mupirocin
INDICATIONS AND DOSE
Bacterial skin infections, particularly those caused by Gram-
positive organisms (except pseudomonal infection)
TO THE SKIN
▶ Child: Apply up to 3 times a day for up to 10 days
▶ Adult: Apply up to 3 times a day for up to 10 days
l SIDE-EFFECTS Burning sensation . local reactions .
pruritus . rash . urticaria
PREGNANCY Manufacturer advises avoid unless potential
l
benefit outweighs risk-no information available.
l BREAST FEEDING No information available
RENAL IMPAIRMENT Manufacturer advises caution when
l
mupirocin ointment used in moderate or severe
impairment because it contain macrogols (polyethylene
glycol).
Bacterial skin infections 1009
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol)
▶ Bactroban (GlaxoSmithKline UK Ltd)
Mupirocin (as Mupirocin calcium) 20 mg per 1 gram Bactroban
2% cream | 15 gram P £5.26 DT price = £5.26
Ointment
▶ MUPIROCIN (Non-proprietary)
Mupirocin 20 mg per 1 gram Mupirocin 2% ointment |
15 gram P £5.35 DT price = £5.35
▶ Bactroban (GlaxoSmithKline UK Ltd)
Mupirocin 20 mg per 1 gram Bactroban 2% ointment |
15 gram P £4.38 DT price = £5.35
Neomycin sulfate 13
Skin
INDICATIONS AND DOSE
Bacterial skin infections
TO THE SKIN
▶ Child: Apply up to 3 times a day, for short-term use
only
▶ Adult: Apply up to 3 times a day, for short-term use
only
l CONTRA-INDICATIONS Neonates
l CAUTIONS
Large areas If large areas of skin are being treated
ototoxicity may be a hazard, particularly in children and the
elderly, and in those with renal impairment.
l SIDE-EFFECTS Sensitisation (cross sensitivity with other
P aminoglycosides may occur)
l LESS SUITABLE FOR PRESCRIBING Neomycin sulfate cream
is less suitable for prescribing.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: cream
Tablet
▶ NEOMYCIN SULFATE (Non-proprietary)
Neomycin sulfate 500 mg Neomycin 500mg tablets |
100 tablet P £34.69
Retapamulin
INDICATIONS AND DOSE
Superficial bacterial skin infection caused by
Staphylococcus aureus and Streptococcus pyogenes (if
resistant to first line topical antibacterials)
TO THE SKIN
▶ Child 9 months–17 years: Apply twice daily for 5 days, to
be applied thinly, maximum area of skin treated 2% of
body surface area, review treatment if no response
within 2–3 days
▶ Adult: Apply twice daily for 5 days, to be applied
thinly, maximum area of skin treated 100 cm2 or
lesion length 10 cm, review treatment if no response
within 2–3 days
CONTRA-INDICATIONS Contact with eyes . contact with
l
mucous membranes
l SIDE-EFFECTS Contact dermatitis . localised erythema .
localised irritation . localised pain . pruritus
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
The Scottish Medicines Consortium has advised (March
2008) that retapamulin (Altargo ®) is not recommended
 1010 Infections of the skin
for use within NHS Scotland for the treatment of
superficial skin infections.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxytoluene
▶ Altargo (GlaxoSmithKline UK Ltd)
Retapamulin 10 mg per 1 gram Altargo 10mg/g ointment |
5 gram P £7.89
Silver sulfadiazine
INDICATIONS AND DOSE
Prophylaxis and treatment of infection in burn wounds
13 TO THE SKIN
▶ Child: Apply daily, may be applied more frequently if
Skin
very exudative
▶ Adult: Apply daily, may be applied more frequently if
very exudative
For conservative management of finger-tip injuries
TO THE SKIN
▶ Child: Apply every 2–3 days, consult product literature
for details
▶ Adult: Apply every 2–3 days, consult product literature
for details
Adjunct to prophylaxis of infection in skin graft donor sites
and extensive abrasions
TO THE SKIN
▶ Adult: (consult product literature)
Adjunct to short-term treatment of infection in pressure
sores
TO THE SKIN
▶ Adult: Apply once daily or on alternate days
As an adjunct to short-term treatment of infection in leg
ulcers
TO THE SKIN
▶ Adult: Apply once daily or on alternate days, not
recommended if ulcer is very exudative
l CONTRA-INDICATIONS Not recommended for neonates
l CAUTIONS G6PD deficiency
CAUTIONS, FURTHER INFORMATION
Large areas Plasma-sulfadiazine concentrations may
approach therapeutic levels with side-effects and
interactions as for sulfonamides if large areas of skin are
treated.
l INTERACTIONS → Appendix 1 (sulfonamides)—if large
amounts given.
May inactivate enzymatic debriding agents—concomitant
use may be inappropriate.
l SIDE-EFFECTS Allergic reactions . argyria (following
treatment of large areas of skin or prolonged use) .
burning . itching . leucopenia . rashes
SIDE-EFFECTS, FURTHER INFORMATION
Severe blood and skin disorders Owing to the association
of sulfonamides with severe blood and skin disorders,
treatment should be stopped immediately if blood
disorders or rashes develop. Leucopenia developing 2–3
days after starting treatment of burns patients is reported
usually to be self-limiting and silver sulfadiazine need not
usually be discontinued provided blood counts are
monitored carefully to ensure return to normality within a
few days.
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated in
patients with sensitivity to sulfonamides.
BNF 70
l PREGNANCY Risk of neonatal haemolysis and
methaemoglobinaemia in third trimester.
l BREAST FEEDING Small risk of kernicterus in jaundiced
infants and of haemolysis in G6PD-deficient infants.
l HEPATIC IMPAIRMENT Manufacturer advises caution if
significant impairment.
l RENAL IMPAIRMENT Manufacturer advises caution if
significant impairment.
l MONITORING REQUIREMENTS Monitor for leucopenia.
l DIRECTIONS FOR ADMINISTRATION Apply with sterile
applicator.
MEDICINAL FORMS
l
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates, propylene glycol
▶ Flamazine (Smith & Nephew Healthcare Ltd)
Sulfadiazine silver 10 mg per 1 gram Flamazine 1% cream |
20 gram P £2.91 | 50 gram P £3.85 DT price = £3.85 |
250 gram P £10.32 DT price = £10.32 | 500 gram P £18.27 DT
price = £18.27
2.2 Fungal skin infections
IMIDAZOLE ANTIFUNGALS
Clotrimazole
INDICATIONS AND DOSE
Fungal skin infections
TO THE SKIN
▶ Child: Apply 2–3 times a day
▶ Adult: Apply 2–3 times a day
l CAUTIONS Contact with eyes and mucous membranes
should be avoided
l SIDE-EFFECTS Local irritation . erythema . hypersensitivity
reactions . itching . mild burning sensation
SIDE-EFFECTS, FURTHER INFORMATION
Treatment should be discontinued if side-effects are
severe.
l PREGNANCY Minimal absorption from skin; not known to
be harmful.
l PRESCRIBING AND DISPENSING INFORMATION Spray may
be useful for application of clotrimazole to large or hairy
areas of the skin.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
▶ Canesten (clotrimazole) (Bayer Plc)
Clotrimazole 10 mg per 1 ml Canesten 1% solution | 20 ml p
£2.30 DT price = £2.30
Cream
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), polysorbates
▶ CLOTRIMAZOLE (Non-proprietary)
Clotrimazole 10 mg per 1 gram Clotrimazole 1% cream |
20 gram p £2.79 DT price = £1.36 | 50 gram p £5.45 DT price =
£3.40
▶ Canesten (clotrimazole) (Bayer Plc)
Clotrimazole 10 mg per 1 gram Canesten 1% cream | 20 gram p
£2.14 DT price = £1.36 | 50 gram p £3.50 DT price = £3.40
Canesten Antifungal 1% cream | 20 gram p £1.85 DT price = £1.36
Clotrimazole 20 mg per 1 gram Canesten 2% thrush cream |
10 gram p no price available | 20 gram p £4.46 DT price = £4.46
Clotrimazole 100 mg per 1 gram Canesten Internal 10% cream |
5 gram p £6.23 DT price = £6.23
Canesten 10% VC cream | 5 gram P £4.50 DT price = £6.23
 BNF 70 Fungal skin infections 1011

Spray ▶ Adult: Apply once daily for maximum 5 days, leave

CAUTIONARY AND ADVISORY LABELS 15 preparation on for 3–5 minutes before rinsing
EXCIPIENTS: May contain Propylene glycol
Prophylaxis of pityriasis versicolor
▶ Canesten (clotrimazole) (Bayer Plc)
Clotrimazole 10 mg per 1 ml Canesten Dermatological 1% spray | TO THE SKIN
40 ml p £4.72 ▶ Child 12–17 years: Apply once daily for up to 3 days
Also available in combination with Hydrocortisone, p. 1030. before sun exposure, leave preparation on for
3–5 minutes before rinsing
▶ Adult: Apply once daily for up to 3 days before sun
Econazole nitrate exposure, leave preparation on for 3–5 minutes before
rinsing
INDICATIONS AND DOSE
l CAUTIONS Avoid contact with eyes . avoid contact with
Fungal skin infections
mucous membranes
TO THE SKIN
▶ Child: Apply twice daily l INTERACTIONS → Appendix 1 (antifungals, imidazole).
▶ Adult: Apply twice daily l SIDE-EFFECTS Erythema . hypersensitivity reactions .
Fungal nail infections itching . mild burning sensation . occasional local
BY TRANSUNGUAL APPLICATION irritation 13
▶ Child: Apply once daily, applied under occlusive SIDE-EFFECTS, FURTHER INFORMATION

Skin
dressing Treatment should be discontinued if side-effects are
▶ Adult: Apply once daily, applied under occlusive severe.
dressing l NATIONAL FUNDING/ACCESS DECISIONS
NHS restrictions Ketoconazole cream is not prescribable
l CAUTIONS Avoid contact with eyes and mucous on the NHS except for seborrhoeic dermatitis and
membranes pityriasis versicolor and endorsed ’SLS’.
l SIDE-EFFECTS Burning sensation . erythema . l EXCEPTIONS TO LEGAL CATEGORY
hypersensitivity reactions . itching . occasional local ▶ For Fungal skin infections in adults A 15-g tube is available
irritation for sale to the public for the treatment of tinea pedis,
SIDE-EFFECTS, FURTHER INFORMATION tinea cruris, and candidal intertrigo.
Treatment should be discontinued if side-effects are ▶ For Seborrhoeic dermatitis and dandruff Can be sold to the
severe. public for the prevention and treatment of dandruff and
l PREGNANCY Minimal absorption from skin; not known to seborrhoeic dermatitis of the scalp as a shampoo
be harmful. formulation containing ketoconazole maximum 2%, in a
pack containing maximum 120 mL and labelled to show a
l MEDICINAL FORMS maximum frequency of application of once every 3 days.
There can be variation in the licensing of different medicines
containing the same drug. l MEDICINAL FORMS
Cream There can be variation in the licensing of different medicines
EXCIPIENTS: May contain Butylated hydroxyanisole, fragrances containing the same drug.
▶ Pevaryl (Janssen-Cilag Ltd) Cream
Econazole nitrate 10 mg per 1 gram Pevaryl 1% cream | EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
30 gram p £3.71 stearyl alcohol), polysorbates, propylene glycol
▶ Brands may include Gyno-Pevaryl 1% cream ▶ Nizoral (Janssen-Cilag Ltd)
Ketoconazole 20 mg per 1 gram Nizoral 2% cream |
30 gram P £4.24 DT price = £4.24
▶ Brands may include Daktarin Gold 2% cream
Ketoconazole Shampoo
EXCIPIENTS: May contain Imidurea
INDICATIONS AND DOSE ▶ KETOCONAZOLE (Non-proprietary)
Tinea pedis Ketoconazole 20 mg per 1 gram Ketoconazole 2% shampoo |
TO THE SKIN USING CREAM 120 ml P £4.86 DT price = £3.27
▶ Adult: Apply twice daily ▶ Nizoral (Janssen-Cilag Ltd, McNeil Products Ltd)
Ketoconazole 20 mg per 1 gram Nizoral 2% shampoo |
Fungal skin infection (not Tinea pedis) 120 ml P £3.59 DT price = £3.27
TO THE SKIN USING CREAM Nizoral Dandruff 2% shampoo | 100 ml p £5.68
▶ Adult: Apply 1–2 times a day ▶ Brands may include Dandrazol 2% shampoo
Treatment of seborrhoeic dermatitis and dandruff
TO THE SKIN
▶ Child 12–17 years: Apply twice weekly for 2–4 weeks, Miconazole
leave preparation on for 3–5 minutes before rinsing
▶ Adult: Apply twice weekly for 2–4 weeks, leave INDICATIONS AND DOSE
preparation on for 3–5 minutes before rinsing Fungal skin infections
Prophylaxis of seborrhoeic dermatitis and dandruff TO THE SKIN
TO THE SKIN ▶ Child: Apply twice daily continuing for 10 days after
▶ Child 12–17 years: Apply every 1–2 weeks, leave lesions have healed
preparation on for 3–5 minutes before rinsing ▶ Adult: Apply twice daily continuing for 10 days after
▶ Adult: Apply every 1–2 weeks, leave preparation on for lesions have healed
3–5 minutes before rinsing Fungal nail infections
Treatment of pityriasis versicolor TO THE SKIN
TO THE SKIN ▶ Child: Apply 1–2 times a day
▶ Child 12–17 years: Apply once daily for maximum 5 days, ▶ Adult: Apply 1–2 times a day
leave preparation on for 3–5 minutes before rinsing
l CAUTIONS Avoid in Acute porphyrias p. 864 . contact with
eyes and mucous membranes should be avoided
 1012 Infections of the skin BNF 70

l INTERACTIONS → Appendix 1 (antifungals, imidazole). OTHER ANTIFUNGALS

l SIDE-EFFECTS
▶ Common or very common Nausea . rash . vomiting Amorolfine
▶ Frequency not known Burning sensation . erythema .
hypersensitivity reactions . itching . occasional local INDICATIONS AND DOSE
irritation Fungal nail infections
SIDE-EFFECTS, FURTHER INFORMATION BY TRANSUNGUAL APPLICATION
Treatment should be discontinued if side effects are ▶ Child: Apply 1–2 times a week for 6 months to treat
severe. finger nail and for toe nails 9–12 months (review at
l PREGNANCY Absorbed from the skin in small amounts; intervals of 3 months), apply to infected nails after
manufacturer advises caution. filing and cleansing, allow to dry for approximately
3 minutes
l BREAST FEEDING Manufacturer advises caution—no
▶ Adult: Apply 1–2 times a week for 6 months to treat
information available.
finger nail and for toe nails 9–12 months (review at
l PROFESSION SPECIFIC INFORMATION intervals of 3 months), apply to infected nails after
Dental practitioners’ formulary filing and cleansing, allow to dry for approximately
Miconazole cream may be prescribed. 3 minutes
13 l NATIONAL FUNDING/ACCESS DECISIONS
NHS restrictions Miconazole nitrate 2% powder is not l UNLICENSED USE Not licensed for use in children under
Skin

prescribable on the NHS. 12 years.

l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Butylated hydroxyanisole
▶ Daktarin (McNeil Products Ltd, Janssen-Cilag Ltd)
Miconazole nitrate 20 mg per 1 gram Daktarin 2% cream |
15 gram p £2.14 | 30 gram p £1.82 DT price = £1.82
▶ Brands may include Gyno-Daktarin 2% vaginal cream
Spray
CAUTIONARY AND ADVISORY LABELS 15
▶ Daktarin (McNeil Products Ltd)
Miconazole nitrate 1.6 mg per 1 gram Daktarin Aktiv 0.16% spray
powder | 100 gram G £3.17 DT price = £3.17
Powder
▶ Daktarin (McNeil Products Ltd)
Miconazole nitrate 20 mg per 1 gram Daktarin 2% powder |
20 gram p £2.58
Tioconazole
INDICATIONS AND DOSE
Fungal nail infection
BY TRANSUNGUAL APPLICATION
▶ Child: Apply twice daily usually for up to 6 months
(may be extended to 12 months), apply to nails and
surrounding skin
▶ Adult: Apply twice daily usually for up to 6 months
(may be extended to 12 months), apply to nails and
surrounding skin
l CAUTIONS Contact with eyes and mucous membranes
should be avoided . use with caution if child likely to suck
affected digits
l SIDE-EFFECTS Burning sensation . dry skin . erythema .
exfoliation . hypersensitivity reactions . itching . local
oedema . nail discoloration . nail pain . occasional local
irritation . periungual inflammation . rash
SIDE-EFFECTS, FURTHER INFORMATION
Treatment should be discontinued if side-effects are
severe.
l PREGNANCY Manufacturer advises avoid.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Paint
▶ Trosyl (Pfizer Ltd)
Tioconazole 283 mg per 1 ml Trosyl 283mg/ml nail solution |
12 ml P £27.38 DT price = £27.38
l CAUTIONS Avoid contact with ears . avoid contact with
eyes and mucous membranes . use with caution in child
likely to suck affected digits
l SIDE-EFFECTS Burning sensation . erythema .
hypersensitivity reactions . itching . occasional local
irritation
SIDE-EFFECTS, FURTHER INFORMATION
Treatment should be discontinued if side-effects are
severe.
l PATIENT AND CARER ADVICE Avoid nail varnish or
artificial nails during treatment.
l EXCEPTIONS TO LEGAL CATEGORY Amorolfine nail lacquer
can be sold to the public if supplied for the treatment of
mild cases of distal and lateral subungual onychomycoses
caused by dermatophytes, yeasts and moulds; subject to
treatment of max. 2 nails, max. strength of nail lacquer
amorolfine 5% and a pack size of 3 mL.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Medicated nail lacquer
CAUTIONARY AND ADVISORY LABELS 10
▶ AMOROLFINE (Non-proprietary)
Amorolfine (as Amorolfine hydrochloride) 50 mg per 1
ml Amorolfine 5% medicated nail lacquer | 3 ml p £12.00 |
5 ml P £16.21 DT price = £5.81
▶ Loceryl (Galderma (UK) Ltd)
Amorolfine (as Amorolfine hydrochloride) 50 mg per 1
ml Loceryl 5% medicated nail lacquer | 2.5 ml P £7.26 |
5 ml P £9.08 DT price = £5.81
▶ Brands may include Curanail 5% medicated nail lacquer, Omicur 5%
medicated nail lacquer
Griseofulvin
INDICATIONS AND DOSE
Tinea pedis
TO THE SKIN
▶ Adult: Apply 400 micrograms once daily, apply to an
area approximately 13 cm2. increased if necessary to
1.2 mg once daily for maximum treatment duration of
4 weeks, allow each spray to dry between application
l CAUTIONS Avoid contact with eyes and mucous
membranes
l SIDE-EFFECTS Burning sensation . erythema .
hypersensitivity reactions . itching . occasional local
irritation
 BNF 70
SIDE-EFFECTS, FURTHER INFORMATION
Treatment should be discontinued if side-effects are
severe.
l PREGNANCY Manufacturer advises avoid unless potential
benefit outweighs risk.
l BREAST FEEDING Manufacturer advises avoid unless
potential benefit outweighs risk.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Spray
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Benzyl alcohol
▶ Grisol AF (Transdermal Ltd)
Griseofulvin 10 mg per 1 gram Grisol AF 1% spray | 20 ml
£3.35
Terbinafine
INDICATIONS AND DOSE
Tinea pedis
TO THE SKIN USING CREAM
▶ Adult: Apply 1–2 times a day for up to 1 week, to be
applied thinly
Tinea corporis
TO THE SKIN USING CREAM
▶ Adult: Apply 1–2 times a day for up to 1–2 weeks, to
be applied thinly, review treatment after 2 weeks
Tinea cruris
TO THE SKIN USING CREAM
▶ Adult: Apply 1–2 times a day for up to 1–2 weeks, to
be applied thinly, review treatment after 2 weeks
Cutaneous candidiasis | Pityriasis versicolor
TO THE SKIN USING CREAM
▶ Adult: Apply 1–2 times a day for 2 weeks, to be applied
thinly, review treatment after 2 weeks
l CAUTIONS Contact with eyes and mucous membranes
should be avoided
l SIDE-EFFECTS Erythema . hypersensitivity reactions .
itching . mild burning sensation . occasional local
irritation
SIDE-EFFECTS, FURTHER INFORMATION
Treatment should be discontinued if side effects are
severe.
l PREGNANCY Manufacturer advises use only if potential
benefit outweighs risk—animal studies suggest no adverse
effects.
l BREAST FEEDING Manufacturer advises avoid—present in
milk. Less than 5% of the dose is absorbed after topical
application of terbinafine; avoid application to mother’s
chest.
l EXCEPTIONS TO LEGAL CATEGORY Preparations of
terbinafine hydrochloride (maximum 1%) can be sold to
the public for use in those over 16 years for external use
for the treatment of tinea pedis as a cream in a pack
containing maximum 15 g, or for the treatment of tinea
pedis and cruris as a cream in a pack containing maximum
15 g, or for the treatment of tinea pedis, cruris, and
corporis as a spray in a pack containing maximum 30 mL
spray or as a gel in a pack containing maximum 30 g gel.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), polysorbates
Fungal skin infections 1013
▶ TERBINAFINE (Non-proprietary)
Terbinafine hydrochloride 10 mg per 1 gram Terbinafine 1%
cream | 7.5 gram P £0.95 | 7.5 gram G £0.95 |
15 gram P £4.86 DT price = £1.69 | 30 gram P £8.76 DT price
= £3.38
▶ Lamisil (Novartis Consumer Health UK Ltd)
Terbinafine hydrochloride 10 mg per 1 gram Lamisil 1% cream |
30 gram P £8.76 DT price = £3.38
Benzoic acid with salicylic acid
INDICATIONS AND DOSE
Ringworm (tinea)
TO THE SKIN
p ▶ Child: Apply twice daily
▶ Adult: Apply twice daily
13
l CAUTIONS Avoid broken or inflamed skin . avoid contact
with eyes . avoid contact with mucous membranes
Skin
CAUTIONS, FURTHER INFORMATION
Salicylate toxicity Salicylate toxicity may occur particularly
if applied on large areas of skin.
l SIDE-EFFECTS Erythema . hypersensitivity reactions .
itching . mild burning sensation . occasional local
irritation
SIDE-EFFECTS, FURTHER INFORMATION
Treatment should be discontinued if side effects are
severe.
l PRESCRIBING AND DISPENSING INFORMATION Benzoic
Acid Ointment, Compound, BP (a preparation containing
benzoic acid and salicylic acid) has also been referred to
as Whitfield’s ointment. When prepared
extemporaneously, the BP states Benzoic Acid Ointment,
Compound BP (Whitfield's ointment) consists of benzoic
acid 6%, salicylic acid 3%, in emulsifying ointment.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment, cream
Boric acid with salicylic acid and tannic
acid
INDICATIONS AND DOSE
Fungal nail infection, particularly tinea
BY TRANSUNGUAL APPLICATION
▶ Child 5–17 years: Apply twice daily, and after washing
▶ Adult: Apply twice daily, and after washing
l CAUTIONS Avoid broken or inflamed skin . contact with
eyes and mucous membranes should be avoided . use with
caution in children likely to suck affected digits
CAUTIONS, FURTHER INFORMATION
Salicylate toxicity Salicylate toxicity can occur particularly
if applied on large areas of skin.
l SIDE-EFFECTS Burning sensation . erythema .
hypersensitivity reactions . itching . occasional local
irritation
SIDE-EFFECTS, FURTHER INFORMATION
Treatment should be discontinued if side-effects are
severe.
l PREGNANCY Avoid.
l LESS SUITABLE FOR PRESCRIBING Phytex ® is less suitable
for prescribing.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
 1014 Infections of the skin BNF 70

Paint Powder
CAUTIONARY AND ADVISORY LABELS 15 EXCIPIENTS: May contain Fragrances
▶ Phytex (Wynlit Laboratories Ltd) ▶ UNDECENOIC ACID WITH ZINC UNDECENOATE (Non-proprietary)
Boric acid 31.2 mg per 1 ml, Methyl salicylate 5.3 mg per 1 ml, Undecenoic acid 20 mg per 1 gram, Zinc undecenoate 200 mg
Salicylic acid 8.9 mg per 1 ml, Tannic acid 48.9 mg per 1 per 1 gram 70 gram G £2.71
ml Phytex paint | 25 ml p £2.97 ▶ Brands may include Mycota

Chlorhexidine with nystatin 2.3 Parasitic skin infections

INDICATIONS AND DOSE
Skin infections due to Candida spp. PARASITICIDES
TO THE SKIN
▶ Child: Apply 2–3 times a day, continuing for 7 days Benzyl benzoate
after lesions have healed
▶ Adult: Apply 2–3 times a day, continuing for 7 days INDICATIONS AND DOSE
after lesions have healed Scabies
13 TO THE SKIN
l CAUTIONS Avoid contact with eyes and mucous ▶ Adult: Apply over the whole body; repeat without
Skin

membranes bathing on the following day and wash off 24 hours

l SIDE-EFFECTS Burning sensation . erythema . later; a third application may be required in some
hypersensitivity reactions . itching . occasional local cases
irritation
SIDE-EFFECTS, FURTHER INFORMATION l CAUTIONS Avoid contact with eyes and mucous
Treatment should be discontinued if side-effects are membranes . children (not recommended) . do not use on
severe. broken or secondarily infected skin
l SIDE-EFFECTS Burning sensation (especially on genitalia
l MEDICINAL FORMS and excoriations) . rashes . skin irritation
There can be variation in the licensing of different medicines
containing the same drug. l BREAST FEEDING Suspend feeding until product has been
Cream washed off.
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including l PRESCRIBING AND DISPENSING INFORMATION Not
cetyl and stearyl alcohol), polysorbates recommended for children—dilution to reduce irritant
▶ Nystaform (Typharm Ltd) effect also reduces efficacy. Some manufacturers
Chlorhexidine hydrochloride 10 mg per 1 gram, Nystatin 100000 recommend application to the body but to exclude the
unit per 1 gram Nystaform cream | 30 gram P £2.62 DT price = head and neck. However, application should be extended
£2.62
to the scalp, neck, face, and ears.
When prepared extemporaneously, the BP states Benzyl
Benzoate Application, BP consists of benzyl benzoate 25%
Undecenoic acid with zinc undecenoate in an emulsion basis.
l LESS SUITABLE FOR PRESCRIBING Benzyl benzoate is less
INDICATIONS AND DOSE
suitable for prescribing.
Treatment of athletes foot
TO THE SKIN l MEDICINAL FORMS
▶ Child: Apply twice daily, continue use for seven days There can be variation in the licensing of different medicines
after lesions have healed containing the same drug. Forms available from special-order
▶ Adult: Apply twice daily, continue use for seven days
manufacturers include: liquid
after lesions have healed
Prevention of athletes foot
TO THE SKIN Dimeticone
▶ Child: Apply once daily
INDICATIONS AND DOSE
▶ Adult: Apply once daily
Head lice
l CAUTIONS Avoid broken skin . contact with eyes should be TO THE SKIN
avoided . contact with mucous membranes should be ▶ Child: Apply once weekly for 2 doses, rub into hair and
avoided scalp, allow to dry naturally, shampoo after minimum
l SIDE-EFFECTS Erythema . hypersensitivity reactions . 8 hours (or overnight)
itching . local irritation . mild burning sensation ▶ Adult: Apply once weekly for 2 doses, rub into hair and
scalp, allow to dry naturally, shampoo after minimum
SIDE-EFFECTS, FURTHER INFORMATION 8 hours (or overnight)
Treatment should be discontinued if side effects are
severe. l UNLICENSED USE Not licensed for use in children under
l MEDICINAL FORMS 6 months except under medical supervision.
There can be variation in the licensing of different medicines l CAUTIONS Avoid contact with eyes . children under
containing the same drug. 6 months, medical supervision required
Cream l SIDE-EFFECTS Skin irritation
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), fragrances l PATIENT AND CARER ADVICE Patients should be told to
▶ UNDECENOIC ACID WITH ZINC UNDECENOATE (Non-proprietary) keep hair away from fire and flames during treatment.
Undecenoic acid 50 mg per 1 gram, Zinc undecenoate 200 mg
per 1 gram 25 gram G £2.01
l MEDICINAL FORMS
▶ Brands may include Mycota
There can be variation in the licensing of different medicines
containing the same drug.
 BNF 70
Liquid
▶ Hedrin (Thornton & Ross Ltd)
Dimeticone 40 mg per 1 gram Hedrin 4% lotion | 50 ml p £2.98
DT price = £2.98 | 150 ml p £6.92 DT price = £6.92
Cutaneous spray solution
▶ Hedrin (Thornton & Ross Ltd)
Dimeticone 40 mg per 1 gram Hedrin 4% spray | 120 ml G ▶ Derbac-M (G.R. Lane Health Products Ltd)
£7.13
Ivermectin
INDICATIONS AND DOSE
Scabies, in combination with topical drugs, for the
treatment of hyperkeratotic (crusted or ‘Norwegian’)
scabies that does not respond to topical treatment alone
BY MOUTH
▶ Adult: 200 micrograms/kg for 1 dose, further doses of
200 micrograms/kg may be required
l UNLICENSED USE Ivermectin is an unlicensed drug.
l SIDE-EFFECTS Aggravation of itching . aggravation of rash
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: tablet
Malathion
INDICATIONS AND DOSE
Head lice
TO THE SKIN
▶ Child: Apply once weekly for 2 doses, rub 0.5%
preparation into dry hair and scalp, allow to dry
naturally, remove by washing after 12 hours
▶ Adult: Apply once weekly for 2 doses, rub 0.5%
preparation into dry hair and scalp, allow to dry
naturally, remove by washing after 12 hours
Crab lice
TO THE SKIN
▶ Child: Apply once weekly for 2 doses, apply 0.5%
aqueous preparation over whole body, allow to dry
naturally, wash off after 12 hours or overnight
▶ Adult: Apply once weekly for 2 doses, apply 0.5%
aqueous preparation over whole body, allow to dry
naturally, wash off after 12 hours or overnight
Scabies
TO THE SKIN
▶ Child: Apply once weekly for 2 doses, apply 0.5%
preparation over whole body, and wash off after 24
hours, if hands are washed with soap within 24 hours,
they should be retreated
▶ Adult: Apply once weekly for 2 doses, apply 0.5%
preparation over whole body, and wash off after 24
hours, if hands are washed with soap within 24 hours,
they should be retreated
l CAUTIONS Alcoholic lotions not recommended for head
lice in children with severe eczema or asthma, or for
scabies or crab lice . avoid contact with eyes . children
under 6 months, medical supervision required . do not use
lotion more than once a week for 3 consecutive weeks . do
not use on broken or secondarily infected skin
l SIDE-EFFECTS Chemical burns . hypersensitivity reactions
. skin irritation
l PRESCRIBING AND DISPENSING INFORMATION For scabies,
manufacturer recommends application to the body but
not necessarily to the head and neck. However,
application should be extended to the scalp, neck, face,
and ears.
Parasitic skin infections 1015
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), fragrances, hydroxybenzoates (parabens)
Malathion 5 mg per 1 gram Derbac-M 0.5% liquid | 50 ml p £3.23
DT price = £3.23 | 200 ml p £7.76 DT price = £7.76
Permethrin
INDICATIONS AND DOSE
Scabies
TO THE SKIN
▶ Child 2 months–17 years: Apply once weekly for 2 doses,
apply 5% preparation over whole body including face, 13
neck, scalp and ears then wash off after 8–12 hours. If
Skin
hands are washed with soap they should be treated
again with cream
▶ Adult: Apply once weekly for 2 doses, apply 5%
preparation over whole body including face, neck,
scalp and ears then wash off after 8–12 hours. If hands
are washed with soap they should be treated again
with cream
Crab lice
TO THE SKIN
Adult: Apply once weekly for 2 doses, apply 5% cream
▶
over whole body, allow to dry naturally and wash off
after 12 hours or after leaving on overnight
Head lice
TO THE SKIN
▶ Adult: Not recommended; no information given
l CAUTIONS Avoid contact with eyes . children aged
2 months–2 years, medical supervision required for
dermal cream (scabies) . do not use on broken or
secondarily infected skin
l SIDE-EFFECTS
▶ Rare Oedema . rashes
Frequency not known Erythema . pruritus . stinging
▶
l PRESCRIBING AND DISPENSING INFORMATION
Manufacturer recommends application to the body but to
exclude head and neck. However, application should be
extended to the scalp, neck, face, and ears.
Larger patients may require up to two 30-g packs for
adequate treatment.
l LESS SUITABLE FOR PRESCRIBING Lyclear® Creme Rinse is
less suitable for prescribing.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ Lyclear (Omega Pharma Ltd)
Permethrin 10 mg per 1 gram Lyclear 1% creme rinse | 59 ml p
£3.55 DT price = £3.55 | 118 ml p £6.46 DT price = £6.46
Cream
CAUTIONARY AND ADVISORY LABELS 10
EXCIPIENTS: May contain Butylated hydroxytoluene, wool fat and
related substances including lanolin
▶ PERMETHRIN (Non-proprietary)
Permethrin 50 mg per 1 gram Permethrin 5% cream |
30 gram p £7.46 DT price = £7.46
▶ Brands may include Lyclear 5% dermal cream
 1016 Inflammatory skin conditions
2.4 Viral skin infections
NUCLEOSIDE ANALOGUES
Aciclovir
(Acyclovir)
INDICATIONS AND DOSE
Herpes simplex infection (local treatment)
TO THE SKIN
▶ Child: Apply 5 times a day for 5–10 days, to be applied
to lesions every 4 hours, starting at first sign of attack
▶ Adult: Apply 5 times a day for 5–10 days, to be applied
to lesions every 4 hours, starting at first sign of attack
13 l CAUTIONS Avoid cream coming in to contact with eyes
and mucous membranes
SIDE-EFFECTS Drying of the skin . erythema . itching of
Skin
l corticosteroids or emollients to treat eczema of the limbs.
the skin . transient burning . transient stinging
l PREGNANCY Limited absorption from topical aciclovir
preparations.
l PATIENT AND CARER ADVICE
Medicines for Children leaflet: Aciclovir cream for herpes
www.medicinesforchildren.org.uk/aciclovir-cream-for-herpes
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Aciclovir Cream may be prescribed.
l EXCEPTIONS TO LEGAL CATEGORY A 2-g tube and a pump
pack are on sale to the public for the treatment of cold
sores.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), propylene glycol
▶ ACICLOVIR (Non-proprietary)
Aciclovir 50 mg per 1 gram Aciclovir 5% cream | 2 gram P
£4.17 DT price = £1.33 | 10 gram P £12.56 DT price = £6.65
▶ Zovirax (GlaxoSmithKline UK Ltd)
Aciclovir 50 mg per 1 gram Zovirax 5% cream | 2 gram P
£4.63 DT price = £1.33 | 10 gram P £13.96 DT price = £6.65
3 Inflammatory skin
conditions
3.1 Eczema and psoriasis
Eczema
Eczema (dermatitis) has several causes, which may
influence treatment. The main types of eczema are irritant,
allergic contact, atopic, venous and discoid; different types
may co-exist. Lichenification, due to scratching and
rubbing, may complicate any chronic eczema. Atopic eczema
is the most common type and it usually involves dry skin as
well as infection and lichenification.
Management of eczema involves the removal or treatment
of contributory factors including occupational and domestic
irritants. Known or suspected contact allergens should be
avoided. Rarely, ingredients in topical medicinal products
may sensitise the skin; the BNF lists active ingredients
together with excipients that have been associated with skin
sensitisation.
BNF 70
Skin dryness and the consequent irritant eczema requires
emollients applied regularly (at least twice daily) and
liberally to the affected area; this can be supplemented with
bath or shower emollients. The use of emollients should
continue even if the eczema improves or if other treatment
is being used.
Topical corticosteroids are also required in the
management of eczema; the potency of the corticosteroid
should be appropriate to the severity and site of the
condition. Mild corticosteroids are generally used on the
face and on flexures; potent corticosteroids are generally
required for use on adults with discoid or lichenified eczema
or with eczema on the scalp, limbs, and trunk. Treatment
should be reviewed regularly, especially if a potent
corticosteroid is required. In patients with frequent flares
(2–3 per month), a topical corticosteroid can be applied on
2 consecutive days each week to prevent further flares.
Bandages (including those containing ichthammol with
zinc oxide p. 1019) are sometimes applied over topical
Dry-wrap dressings can be used to provide a physical barrier
to help prevent scratching and improve retention of
emollients. See Wound management products and
elasticated garments p. 1294 for details of elasticated
viscose stockinette tubular bandages and garments, and silk
clothing.
See Eczema and psoriasis, drugs affecting the immune
response p. 1017 for the role of topical pimecrolimus
p. 1019 and tacrolimus p. 1020 in atopic eczema.
Infection
Bacterial infection (commonly with Staphylococcus aureus
and occasionally with Streptococcus pyogenes) can
exacerbate eczema and requires treatment with topical or
systemic antibacterial drugs. Antibacterial drugs should be
used in short courses (typically 1 week) to reduce the risk of
drug resistance or skin sensitisation. Associated eczema is
treated simultaneously with a topical corticosteroid which
can be combined with a topical antimicrobial.
Eczema involving widespread or recurrent infection
requires the use of a systemic antibacterial that is active
against the infecting organism. Products that combine an
antiseptic with an emollient application and with a bath
emollient can also be used; antiseptic shampoos can be
used on the scalp.
Intertriginous eczema commonly involves candida and
bacteria; it is best treated with a mild or moderately potent
topical corticosteroid and a suitable antimicrobial drug.
Widespread herpes simplex infection may complicate
atopic eczema and treatment with a systemic antiviral drug
is indicated.
Management of other features of eczema
Lichenification, which results from repeated scratching is
treated initially with a potent corticosteroid. Bandages
containing ichthammol paste p. 1019 (to reduce pruritus)
and other substances such as zinc oxide can be applied over
the corticosteroid or emollient. Coal tar and ichthammol
can be useful in some cases of chronic eczema.
A non-sedating antihistamine may be of some value in
relieving severe itching or urticaria associated with eczema.
A sedating antihistamine can be used if itching causes sleep
disturbance.
Exudative (‘weeping’) eczema requires a potent
corticosteroid initially; infection may also be present and
require specific treatment. Potassium permanganate p. 1052
solution (1 in 10,000) can be used in exudating eczema for
its antiseptic and astringent effects; treatment should be
stopped when exudation stops.
Severe refractory eczema
Severe refractory eczema is best managed under specialist
supervision; it may require phototherapy or drugs that act
on the immune system. Alitretinoin p. 1033 is licensed for
 BNF 70
the treatment of severe chronic hand eczema refractory to
potent topical corticosteroids; patients with hyperkeratotic
features are more likely to respond to alitretinoin than
those with pompholyx.
Seborrhoeic dermatitis
Seborrhoeic dermatitis (seborrhoeic eczema) is associated with
species of the yeast Malassezia and affects the scalp,
paranasal areas, and eyebrows. Shampoos active against the
yeast (including those containing ketoconazole p. 1011 and
coal tar) and combinations of mild corticosteroids with
suitable antimicrobials are used.
Eczema and psoriasis, drugs
affecting the immune response
Drugs affecting the immune response are used for eczema
or psoriasis. Systemic drugs acting on the immune system
are used under specialist supervision.
Pimecrolimus p. 1019 by topical application is licensed for
mild to moderate atopic eczema. Tacrolimus p. 1020 is
licensed for topical use in moderate to severe atopic eczema.
Both are drugs whose long-term safety is still being
evaluated and they should not usually be considered first-
line treatments unless there is a specific reason to avoid or
reduce the use of topical corticosteroids. Treatment of
atopic eczema with topical pimecrolimus or topical
tacrolimus should be initiated only by prescribers
experienced in managing the condition. Topical tacrolimus
and pimecrolimus have a role in the treatment of psoriasis.
A short course of a systemic corticosteroid can be given
for eczema flares that have not improved despite
appropriate topical treatment.
Ciclosporin p. 717 by mouth can be used for severe
psoriasis and for severe eczema. Azathioprine p. 716 or
mycophenolate mofetil p. 725 are used for severe refractory
eczema [unlicensed indication].
Methotrexate p. 762 can be used for severe psoriasis, the
dose being adjusted according to severity of the condition
and haematological and biochemical measurements. Folic
acid p. 836 should be given to reduce the possibility of side-
effects associated with methotrexate. Folic acid can be given
once weekly [unlicensed indication], on a different day from
the methotrexate; alternative regimens of folic acid may be
used in some settings.
Etanercept p. 903, adalimumab p. 901, and infliximab
p. 906 inhibit the activity of tumour necrosis factor (TNFa).
They are used for severe plaque psoriasis either refractory to
at least 2 standard systemic treatments and
photochemotherapy, or when standard treatments cannot
be used because of intolerance or contra-indications; while
either etanercept or adalimumab is considered to be the
first choice in stable disease, infliximab or adalimumab may
be useful when rapid disease control is required.
Ustekinumab p. 899 (a monoclonal antibody that inhibits
interleukins 12 and 23) can be used for severe plaque
psoriasis that has not responded to at least 2 standard
systemic treatments and photochemotherapy, or when
these treatments cannot be used because of intolerance or
contra-indications. Adalimumab, etanercept, infliximab and
ustekinumab are also licensed for psoriatic arthritis.
Psoriasis
Psoriasis is characterised by epidermal thickening and
scaling. It commonly affects extensor surfaces and the scalp.
Occasionally, psoriasis is provoked or exacerbated by
drugs such as lithium, chloroquine and hydroxychloroquine,
beta-blockers, non-steroidal anti-inflammatory drugs, and
Eczema and psoriasis 1017
ACE inhibitors. Psoriasis may not be seen until the drug has
been taken for weeks or months.
Emollients, in addition to their effects on dryness,
scaling and cracking, may have an anti-proliferative effect
in psoriasis, and may be the only treatment necessary for
mild psoriasis. They are particularly useful in inflammatory
psoriasis and in plaque psoriasis of palms and soles, in which
irritant factors can perpetuate the condition. Emollients are
useful adjuncts to other more specific treatment.
More specific topical treatment for chronic stable plaque
psoriasis on extensor surfaces of trunk and limbs involves
the use of vitamin D analogues, coal tar p. 1034, dithranol
p. 1018, and the retinoid tazarotene p. 1034. However, they
can irritate the skin and they are not suitable for the more
inflammatory forms of psoriasis; their use should be
suspended during an inflammatory phase of psoriasis. The
efficacy and the irritancy of each substance varies between
patients. If a substance irritates significantly, it should be 13
stopped or the concentration reduced; if it is tolerated, its
Skin
effects should be assessed after 4 to 6 weeks and treatment
continued if it is effective.
Scalp psoriasis is usually scaly, and the scale may be thick
and adherent; this will require softening with an emollient
cream, ointment, or oil. A tar-based shampoo is first-line
treatment for scalp psoriasis; a keratolytic, such as salicylic
acid, should also be used if there is significant scaling, to
allow other treatments to work.
Some preparations prescribed for psoriasis affecting the
scalp, combine salicylic acid with coal tar or sulfur. The
product should be applied generously, and an adequate
quantity should be prescribed. It should be left on for at
least an hour, often more conveniently overnight, before
washing off. The use of scalp preparations containing a
potent corticosteroid or a vitamin D analogue, either alone
or in combination, can also be helpful.
Facial, flexural and genital psoriasis can be managed with
short-term use of a mild or moderate potency topical
corticosteroid (a mild potency topical corticosteroid is
preferred for the initial treatment of facial psoriasis).
Calcitriol p. 1037 or tacalcitol p. 1037 can be used for
longer-term treatment, or if the response to mild or
moderate potency topical corticosteroids is inadequate;
calcipotriol p. 1036 is more likely to cause irritation. Low
strength tar preparations can also be used. Pimecrolimus
p. 1019 or tacrolimus p. 1020 by topical application
[unlicensed indication] can be used short-term, under
specialist supervision, in patients whose condition has not
responded adequately to other treatments, or who are
intolerant of them.
Widespread unstable psoriasis of erythrodermic or
generalised pustular type requires urgent specialist
assessment. Initial topical treatment should be limited to
using emollients frequently and generously; emollients
should be prescribed in quantities of 1 kg or more. More
localised acute or subacute inflammatory psoriasis with hot,
spreading or itchy lesions, should be treated topically with
emollients or with a corticosteroid of moderate potency.
Calcipotrioland tacalcitol are analogues of vitamin D that
affect cell division and differentiation. Calcitriol is an active
form of vitamin D. Vitamin D and its analogues are used
first-line for the long-term treatment of plaque psoriasis;
they do not smell or stain and they may be more acceptable
than tar or dithranol products. Of the vitamin D analogues,
tacalcitol and calcitriol are less likely to irritate.
Coal tar has anti-inflammatory properties that are useful
in chronic plaque psoriasis; it also has antiscaling
properties. Crude coal tar (coal tar, BP) is the most effective
form, typically in a concentration of 1 to 10% in a soft
paraffin base, but few outpatients tolerate the smell and
mess. Cleaner extracts of coal tar included in proprietary
preparations, are more practicable for home use but they
are less effective and improvement takes longer. Contact of
 1018 Inflammatory skin conditions
coal tar products with normal skin is not normally harmful
and they can be used for widespread small lesions; however,
irritation, contact allergy, and sterile folliculitis can occur.
The milder tar extracts can be used on the face and flexures.
Tar baths and tar shampoos are also helpful.
Dithranol below is effective for chronic plaque psoriasis.
Its major disadvantages are irritation (for which individual
susceptibility varies) and staining of skin and of clothing.
Dithranol below is not generally suitable for widespread
small lesions nor should it be used in the flexures or on the
face. Proprietary preparations are more suitable for home
use; they are usually washed off after 5 to 60 minutes
(‘short contact’). Specialist nurses may apply intensive
treatment with dithranol below paste which is covered by
stockinette dressings and usually retained overnight.
Dithranol below should be discontinued if even a low
concentration causes acute inflammation; continued use
13 can result in the psoriasis becoming unstable.
Tazarotene p. 1034, a retinoid, has a similar efficacy to
Skin
vitamin D and its analogues, but is associated with a greater
incidence of irritation. Although irritation is common, it is
minimised by applying tazarotene sparingly to the plaques
and avoiding normal skin; application to the face and in
flexures should also be avoided. Tazarotene does not stain
and is odourless.
A topical corticosteroid is not generally suitable for long-
term use or as the sole treatment of extensive chronic
plaque psoriasis; any early improvement is not usually
maintained and there is a risk of the condition deteriorating
or of precipitating an unstable form of psoriasis (e.g.
erythrodermic psoriasis or generalised pustular psoriasis) on
withdrawal. Topical use of potent corticosteroids on
widespread psoriasis can also lead to systemic as well as
local side-effects. However, topical corticosteroids used
short-term may be appropriate to treat psoriasis in specific
sites such as the face or flexures (with a mild or moderate
corticosteroid), and psoriasis of the scalp, palms, and soles
(with a potent corticosteroid). Very potent corticosteroids
should only be used under specialist supervision.
Combining the use of a corticosteroid with another
specific topical treatment may be beneficial in chronic
plaque psoriasis; the drugs may be used separately at
different times of the day or used together in a single
formulation. Eczema co-existing with psoriasis may be
treated with a corticosteroid, or coal tar, or both.
Phototherapy
Phototherapy is available in specialist centres under the
supervision of a dermatologist. Ultraviolet B (UVB)
radiation is usually effective for chronic stable psoriasis and
for guttate psoriasis. It may be considered for patients with
moderately severe psoriasis in whom topical treatment has
failed, but it may irritate inflammatory psoriasis.
Photochemotherapy combining long-wave ultraviolet A
radiation with a psoralen (PUVA) is available in specialist
centres under the supervision of a dermatologist. The
psoralen, which enhances the effect of irradiation, is
administered either by mouth or topically. PUVA is effective
in most forms of psoriasis, including localised palmoplantar
pustular psoriasis. Early adverse effects include
phototoxicity and pruritus. Higher cumulative doses
exaggerate skin ageing, increase the risk of dysplastic and
neoplastic skin lesions, especially squamous cancer, and
pose a theoretical risk of cataracts.
Phototherapy combined with coal tar, dithranol,
tazarotene, topical vitamin D or vitamin D analogues, or
oral acitretin, allows reduction of the cumulative dose of
phototherapy required to treat psoriasis.
Systemic treatment
Systemic treatment is required for severe, resistant,
unstable or complicated forms of psoriasis, and it should be
initiated only under specialist supervision. Systemic drugs
for psoriasis include acitretin and drugs that affect the
BNF 70
immune response (such as ciclosporin p. 717 and
methotrexate p. 762).
Systemic corticosteroids should be used only rarely in
psoriasis because rebound deterioration may occur on
reducing the dose.
Acitretin p. 1032, a metabolite of etretinate, is a retinoid
(vitamin A derivative); it is prescribed by specialists. The
main indication for acitretin is psoriasis, but it is also used
in disorders of keratinisation such as severe Darier’s disease
(keratosis follicularis), and some forms of ichthyosis.
Although a minority of cases of psoriasis respond well to
acitretin alone, it is only moderately effective in many cases
and it is combined with other treatments. A therapeutic
effect occurs after 2 to 4 weeks and the maximum benefit
after 4 months. Consideration should be given to stopping
acitretin if the response is inadequate after 4 months at the
optimum dose. The manufacturers of acitretin do not
recommend continuous treatment for longer than 6
months. However, some patients may benefit from longer
treatment, provided that the lowest effective dose is used,
patients are monitored carefully for adverse effects, and the
need for treatment is reviewed regularly.
Apart from teratogenicity, which remains a risk for 3 years
after stopping, acitretin is the least toxic systemic treatment
for psoriasis; in women with a potential for child-bearing,
the possibility of pregnancy must be excluded before
treatment and effective contraception must be used during
treatment and for at least 3 years afterwards (oral
progestogen-only contraceptives not considered effective).
Topical treatment
The vitamin D and analogues, calcipotriol p. 1036, calcitriol
p. 1037, and tacalcitol p. 1037 are used for the management
of plaque psoriasis. They should be avoided by those with
calcium metabolism disorders, and used with caution in
generalised pustular or erythrodermic exfoliative psoriasis
(enhanced risk of hypercalcaemia).
ANTRACEN DERIVATIVES
Dithranol
(Anthralin)
INDICATIONS AND DOSE
Subacute and chronic psoriasis
TO THE SKIN
▶ Adult: (consult product literature)
DITHROCREAM ®
Subacute and chronic psoriasis
TO THE SKIN
▶ Adult: For application to skin or scalp, 0.1–0.5% cream
suitable for overnight treatment, 1–2% cream for
maximum 1 hour (consult product literature)
MICANOL ®
Subacute and chronic psoriasis
TO THE SKIN
▶ Adult: Apply once daily, for application to skin or
scalp, to be applied for up to 30 minutes, apply 1%
cream, if necessary 3% cream can be used under
medical supervision
l CONTRA-INDICATIONS Acute and pustular psoriasis .
hypersensitivity
l CAUTIONS Avoid sensitive areas of skin . avoid use near
eyes
l SIDE-EFFECTS Local burning sensation . local irritation .
stains hair . stains skin
l PREGNANCY No adverse effects reported.
l BREAST FEEDING No adverse effects reported.
 BNF 70
l DIRECTIONS FOR ADMINISTRATION When applying
dithranol, hands should be protected by gloves or they
should be washed thoroughly afterwards. Dithranol
should be applied to chronic extensor plaques only,
carefully avoiding normal skin.
MICANOL ® At the end of contact time, use plenty of
lukewarm (not hot) water to rinse off cream; soap may be
used after the cream has been rinsed off; use shampoo
before applying cream to scalp and if necessary after
cream has been rinsed off.
l PRESCRIBING AND DISPENSING INFORMATION Treatment
should be started with a low concentration such as
dithranol 0.1%, and the strength increased gradually
every few days up to 3%, according to tolerance.
When prepared extemporaneously, the BP states
Dithranol Paste, BP consists of dithranol in zinc and
salicylic acid (Lassar’s) paste. Usual strengths 0.1–1% of
dithranol. Dithranol Ointment BP, consists of dithranol,
in yellow soft paraffin; usual strengths 0.1–2%. Part of
basis may be replaced by hard paraffin if a stiffer
preparation is required.
l PATIENT AND CARER ADVICE Dithranol can stain the skin,
hair and fabrics.
l EXCEPTIONS TO LEGAL CATEGORY Prescription only
medicine if dithranol content more than 1%, otherwise
may be sold to the public.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol
▶ Dithrocream (Dermal Laboratories Ltd)
Dithranol 1 mg per 1 gram Dithrocream 0.1% cream | 50 gram p
£3.77
Dithranol 2.5 mg per 1 gram Dithrocream 0.25% cream |
50 gram p £4.04
Dithranol 5 mg per 1 gram Dithrocream 0.5% cream | 50 gram p
£4.66
Dithranol 10 mg per 1 gram Dithrocream HP 1% cream |
50 gram p £5.42
Dithranol 20 mg per 1 gram Dithrocream 2% cream |
50 gram P £5.77
▶ Micanol (Derma UK Ltd)
Dithranol 10 mg per 1 gram Micanol 1% cream | 50 gram p
£16.18
Dithranol 30 mg per 1 gram Micanol 3% cream | 50 gram P
£20.15
Dithranol with salicylic acid and zinc
oxide
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, dithranol p. 1018, salicylic acid p. 1057.
INDICATIONS AND DOSE
Subacute and chronic psoriasis
TO THE SKIN
▶ Adult: (consult local protocol)
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment, paste
Eczema and psoriasis 1019
BACTERIOSTATICS
Ichthammol
INDICATIONS AND DOSE
Chronic lichenified eczema
TO THE SKIN
▶ Child 1–17 years: Apply 1–3 times a day
▶ Adult: Apply 1–3 times a day
l SIDE-EFFECTS Skin irritation
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Ichthammol
Ointment, BP 1980 consists of ichthammol 10%, white
soft paraffin 45% and wool fat 45%.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines 13
containing the same drug. Forms available from special-order
Skin
manufacturers include: paste, ointment
Liquid
▶ ICHTHAMMOL (Non-proprietary)
Ichthammol 1 mg per 1 mg Ichthammol liquid | 100 gram G
£11.42 DT price = £11.42 | 500 gram G £34.27
Ichthammol with zinc oxide
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, ichthammol above.
INDICATIONS AND DOSE
Chronic lichenified eczema
TO THE SKIN
▶ Adult: (consult product literature)
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Zinc and
Ichthammol Cream, BP consists of ichthammol 5%,
cetostearyl alcohol 3%, wool far 10%, in zinc cream.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment, cream
Impregnated dressing
▶ ICHTHAMMOL WITH ZINC OXIDE (Non-proprietary)
Ichthopaste bandage 7.5cm x 6m | 1 bandage £3.67
CALCINEURIN INHIBITORS AND RELATED DRUGS
Pimecrolimus
INDICATIONS AND DOSE
Short-term treatment of mild to moderate atopic eczema
(including flares) when topical corticosteroids cannot be
used (initiated by a specialist)
TO THE SKIN
▶ Adult: Apply twice daily until symptoms resolve (stop
treatment if eczema worsens or no response after
6 weeks)
Short-term treatment of facial, flexural, or genital psoriasis
in patients unresponsive to, or intolerant of other topical
therapy (initiated by a specialist)
TO THE SKIN
▶ Adult: Apply twice daily until symptoms resolve
(maximum duration of treatment 4 weeks)
l UNLICENSED USE Pimecrolimus is not licensed for short-
term treatment of facial, flexural, or genital psoriasis in
patients unresponsive to, or intolerant of other topical
therapy.
 1020 Inflammatory skin conditions
l CONTRA-INDICATIONS Application to malignant or
potentially malignant skin lesions . application under
occlusion . congenital epidermal barrier defects . contact
with eyes . contact with mucous membranes . generalised
erythroderma . immunodeficiency . infection at treatment
site
l CAUTIONS Alcohol consumption (risk of facial flushing
and skin irritation) . avoid other topical treatments except
emollients at treatment site . UV light (avoid excessive
exposure to sunlight and sunlamps)
l INTERACTIONS Concomitant use with drugs that cause
immunosuppression is contra-indicated (may be
prescribed in exceptional circumstances by specialists).
l SIDE-EFFECTS
▶ Common or very common Burning sensation . erythema .
folliculitis . pruritus . skin infections
13 ▶ Uncommon Herpes simplex . herpes zoster . impetigo .
molluscum contagiosum
Rare Dryness . local reactions including pain . oedema .
Skin
▶
papilloma . paraesthesia . peeling . skin discoloration .
worsening of eczema
▶ Frequency not known Skin malignancy
l PREGNANCY Manufacturer advises avoid; toxicity in
animal studies following systemic administration.
l BREAST FEEDING Manufacturer advises caution; ensure
infant does not come in contact with treated areas.
l NATIONAL FUNDING/ACCESS DECISIONS
NICE technology appraisals (TAs)
▶ Tacrolimus and pimecrolimus for atopic eczema (August
2004) NICE TA82
Topical pimecrolimus is an option for atopic eczema not
controlled by maximal topical corticosteroid treatment or
if there is a risk of important corticosteroid side-effects
(particularly skin atrophy). Topical pimecrolimus is
recommended for moderate atopic eczema on the face
and neck of children aged 2–16 years. Pimecrolimus
should be used within its licensed indications.
www.nice.org.uk/TA82
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 4, 11, 28
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), propylene glycol
▶ Elidel (Meda Pharmaceuticals Ltd)
Pimecrolimus 10 mg per 1 gram Elidel 1% cream | 30 gram P
£19.69 DT price = £19.69 | 60 gram P £37.41 DT price = £37.41 |
100 gram P £59.07 DT price = £59.07
Tacrolimus
l DRUG ACTION Tacrolimus is a calcineurin inhibitor.
INDICATIONS AND DOSE
Short-term treatment of moderate to severe atopic eczema
(including flares) in patients unresponsive to, or intolerant
of conventional therapy
TO THE SKIN
▶ Adult: Apply twice daily until lesion clears (consider
other treatment if eczema worsens or no improvement
after 2 weeks), initially 0.1% ointment to be applied
thinly, reduce frequency to once daily or strength of
ointment to 0.03% if condition allows
BNF 70
Prevention of flares in patients with moderate to severe
atopic eczema and 4 or more flares a year who have
responded to initial treatment with topical tacrolimus
TO THE SKIN
▶ Adult: Apply twice weekly, 0.1% ointment to be
applied thinly, with an interval of 2–3 days between
applications, use short-term treatment regimen during
an acute flare; review need for preventative therapy
after 1 year
Short-term treatment of facial, flexural, or genital psoriasis
in patients unresponsive to, or intolerant of other topical
therapy
TO THE SKIN
▶ Adult: Apply twice daily until symptoms resolve, 0.1%
ointment to be applied thinly, reduce to once daily or
switch to 0.03% ointment if condition allows,
maximum duration of treatment 4 weeks
l UNLICENSED USE Short-term treatment of facial, flexural,
or genital psoriasis is unlicensed.
l CONTRA-INDICATIONS Application to malignant or
potentially malignant skin lesions . application under
occlusion . avoid contact with eyes . avoid contact with
mucous membranes . congenital epidermal barrier defects
. generalised erythroderma . immunodeficiency . infection
at treatment site
l CAUTIONS UV light (avoid excessive exposure to sunlight
and sunlamps)
l INTERACTIONS Interactions do not generally apply to
tacrolimus used topically. Concomitant use with drugs
that cause immunosuppression (may be prescribed in
exceptional circumstances by specialists). Risk of facial
flushing and skin irritation with alcohol consumption
(does not apply to tacrolimus taken systemically).
l SIDE-EFFECTS
▶ Common or very common Application-site infections .
application-site reactions . herpes simplex infection .
irritation (at application-site) . Kaposi’s varicelliform
eruption . pain at application-site . rash
▶ Uncommon Acne
▶ Frequency not known Cutaneous lymphoma . malignancies
. other types of lymphomas . rosacea . skin malignancy
l PREGNANCY Manufacturer advises avoid unless essential;
toxicity in animal studies following systemic
administration.
l BREAST FEEDING Avoid—present in milk (following
systemic administration).
l NATIONAL FUNDING/ACCESS DECISIONS
NICE technology appraisals (TAs)
▶ Tacrolimus and pimecrolimus for atopic eczema (August
2004) NICE TA82
Topical tacrolimus is an option for atopic eczema not
controlled by maximal topical corticosteroid treatment or
if there is a risk of important corticosteroid side-effects
(particularly skin atrophy).
Topical tacrolimus is recommended for moderate to
severe atopic eczema in adults and children over 2
years.Tacrolimus should be used within its licensed
indications. www.nice.org.uk/TA82
Scottish Medicines Consortium (SMC) Decisions
The Scottish Medicines Consortium has advised (March
2010) that tacrolimus ointment (Protopic ®) is accepted for
restricted use within NHS Scotland for the prevention of
flares in patients aged over 2 years with moderate to
severe atopic eczema in accordance with the licensed
indications; initiation of treatment is restricted to doctors
(including general practitioners) with a specialist interest
and experience in treating atopic eczema with
immunomodulatory therapy.
 BNF 70 Eczema and psoriasis 1021

l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: paste
Ointment
CAUTIONARY AND ADVISORY LABELS 4, 11, 28
EXCIPIENTS: May contain Beeswax
▶ Protopic (Astellas Pharma Ltd)
Tacrolimus (as Tacrolimus monohydrate) 300 microgram per 1
gram Protopic 0.03% ointment | 30 gram P £19.44 DT price =
£19.44 | 60 gram P £35.46 DT price = £35.46
Tacrolimus (as Tacrolimus monohydrate) 1 mg per 1
gram Protopic 0.1% ointment | 30 gram P £21.60 DT price =
£21.60 | 60 gram P £39.40 DT price = £39.40
CORTICOSTEROIDS
Topical corticosteroids
Topical corticosteroids are used for the treatment of
also increase the risk of side effects; they are therefore used
only under supervision on a short-term basis for areas of
very thick skin (such as the palms and soles). The inclusion
of urea or salicylic acid also increases the penetration of the
corticosteroid.
In the BNF publications topical corticosteroids for the
skin are categorised as ‘mild’, ‘moderately potent’, ‘potent’
or ‘very potent’; the least potent preparation which is
effective should be chosen but dilution should be avoided
whenever possible.
Absorption through the skin
Mild and moderately potent topical corticosteroids are
associated with few side-effects but care is required in the
use of potent and very potent corticosteroids. Absorption
through the skin can rarely cause adrenal suppression and
even Cushing’s syndrome, depending on the area of the
body being treated and the duration of treatment.
Absorption is greatest where the skin is thin or raw, and
13
from intertriginous areas; it is increased by occlusion.

Skin
inflammatory conditions of the skin (other than those
arising from an infection), in particular eczema, contact Suitable quantities of corticosteroid
dermatitis, insect stings, and eczema of scabies. preparations to be prescribed for
Corticosteroids suppress the inflammatory reaction during
use; they are not curative and on discontinuation a rebound specific areas of the body
exacerbation of the condition may occur. They are generally Area of body Creams and Ointments
used to relieve symptoms and suppress signs of the disorder
Face and neck 15 to 30 g
when other measures such as emollients are ineffective.
Topical corticosteroids are not recommended in the Both hands 15 to 30 g
routine treatment of urticaria; treatment should only be Scalp 15 to 30 g
initiated and supervised by a specialist. They should not be
Both arms 30 to 60g
used indiscriminately in pruritus (where they will only
benefit if inflammation is causing the itch) and are not Both legs 100 g
recommended for acne vulgaris. Trunk 100 g
Systemic or very potent topical corticosteroids should be Groins and genitalia 15 to 30 g
avoided or given only under specialist supervision in
psoriasis because, although they may suppress the psoriasis These amounts are usually suitable for an adult for a single daily
in the short term, relapse or vigorous rebound occurs on application for 2 weeks
withdrawal (sometimes precipitating severe pustular
psoriasis). See the role of topical corticosteroids in the
treatment of psoriasis. Compound preparations
In general, the most potent topical corticosteroids should The advantages of including other substances (such as
be reserved for recalcitrant dermatoses such as chronic antibacterials or antifungals) with corticosteroids in topical
discoid lupus erythematosus, lichen simplex chronicus, preparations are uncertain, but such combinations may
hypertrophic lichen planus, and palmoplantar pustulosis. have a place where inflammatory skin conditions are
Potent corticosteroids should generally be avoided on the associated with bacterial or fungal infection, such as
face and skin flexures, but specialists occasionally prescribe infected eczema. In these cases the antimicrobial drug
them for use on these areas in certain circumstances. should be chosen according to the sensitivity of the
When topical treatment has failed, intralesional infecting organism and used regularly for a short period
corticosteroid injections may be used. These are more (typically twice daily for 1 week). Longer use increases the
effective than the very potent topical corticosteroid likelihood of resistance and of sensitisation.
preparations and should be reserved for severe cases where The keratolytic effect of salicylic acid p. 1057 facilitates
there are localised lesions such as keloid scars, hypertrophic the absorption of topical corticosteroids; however, excessive
lichen planus, or localised alopecia areata. and prolonged use of topical preparations containing
salicylic acid p. 1057 may cause salicylism.
Perioral lesions
Hydrocortisone cream 1% p. 993 can be used for up to 7 Topical corticosteroid preparation potencies
days to treat uninfected inflammatory lesions on the lips.
Potency of a topical corticosteroid preparation is a result of
Hydrocortisone with miconazole p. 1031 cream or ointment
the formulation as well as the corticosteroid. Therefore,
is useful where infection by susceptible organisms and
proprietary names are shown.
inflammation co-exist, particularly for initial treatment (up
Mild
to 7 days) e.g. in angular cheilitis. Organisms susceptible to
. Hydrocortisone 0.1–2.5%
miconazole include Candida spp. and many Gram-positive
. Dioderm
bacteria including streptococci and staphylococci.
. Mildison
Choice of formulation . Synalar 1 in 10 dilution
Mild with antimicrobials
Water-miscible corticosteroid creams are suitable for moist
. Canesten HC
or weeping lesions whereas ointments are generally chosen
. Daktacort
for dry, lichenified or scaly lesions or where a more
. Econacort
occlusive effect is required. Lotions may be useful when
. Fucidin H
minimal application to a large or hair-bearing area is
. Nystaform-HC
required or for the treatment of exudative lesions. Occlusive
. Terra-Cortril
polythene or hydrocolloid dressings increase absorption, but
. Timodine
 1022 Inflammatory skin conditions BNF 70

Moderate
. Betnovate-RD Corticosteroids (topical) f
. Eumovate l CONTRA-INDICATIONS Acne . perioral dermatitis . potent
. Haelan corticosteroids in widespread plaque psoriasis . rosacea .
. Modrasone untreated bacterial, fungal or viral skin lesions
. Synalar 1 in 4 Dilution l CAUTIONS Avoid prolonged use (particularly on the face) .
. Ultralanum Plain cautions applicable to systemic corticosteroids may also
Moderate with antimicrobials apply if absorption occurs following topical and local use .
. Trimovate infection . keep away from eyes . use potent or very potent
Moderate with urea topical corticosteroids under specialist supervision in
. Alphaderm psoriasis (can result in rebound relapse, development of
Potent generalised pustular psoriasis, and local and systemic
. Beclometasone dipropionate 0.025% toxicity)
. Betamethasone valerate 0.1%
. Betacap l SIDE-EFFECTS
. Betesil ▶ Rare Adrenal suppression . Cushing’s syndrome
. Bettamousse ▶ Frequency not known Acne . contact dermatitis .
13 . Betnovate hypertrichosis . irreversible striae atrophicae . irreversible
. Cutivate telangiectasia . mild depigmentation (may be reversible) .
perioral dermatitis . side-effects applicable to systemic
Skin

. Diprosone
. Elocon corticosteroids may also apply if absorption occurs
. Hydrocortisone butyrate following topical and local use . spread and worsening of
. Locoid untreated infection . thinning of the skin (may be restored
. Locoid Crelo over a period after stopping treatment but the original
. Metosyn structure may never return) . worsening of acne .
. Mometasone furoate 0.1% worsening of rosacea
. Nerisone SIDE-EFFECTS, FURTHER INFORMATION
. Synalar In order to minimise the side-effects of a topical
Potent with antimicrobials corticosteroid, it is important to apply it thinly to
. Aureocort affected areas only, no more frequently than twice daily,
. Betamethasone and clioquinol and to use the least potent formulation which is fully
. Betamethasone and neomycin effective.
. Fucibet l DIRECTIONS FOR ADMINISTRATION Topical corticosteroid
. Lotriderm preparations should be applied no more frequently than
. Synalar C twice daily; once daily is often sufficient. Topical
. Synalar N corticosteroids should be spread thinly on the skin but in
Potent with salicylic acid sufficient quantity to cover the affected areas. The length
. Diprosalic of cream or ointment expelled from a tube may be used to
Very potent specify the quantity to be applied to a given area of skin.
. Clarelux This length can be measured in terms of a fingertip unit
. Dermovate (the distance from the tip of the adult index finger to the
. Etrivex first crease). One fingertip unit (approximately 500 mg
. Nerisone Forte from a tube with a standard 5 mm diameter nozzle) is
Very potent with antimicrobials sufficient to cover an area that is twice that of the flat
. Clobetasol with neomycin and nystatin adult handprint (palm and fingers). Mixing topical
preparations on the skin should be avoided where
Use in children possible; several minutes should elapse between
Children, especially infants, are particularly susceptible to application of different preparations.
side-effects. However, concern about the safety of topical l PRESCRIBING AND DISPENSING INFORMATION The potency
corticosteroids in children should not result in the child of each topical corticosteroid should be included on the
being undertreated. The aim is to control the condition as label with the directions for use. The label should be
well as possible; inadequate treatment will perpetuate the attached to the container (for example, the tube) rather
condition. A mild corticosteroid such as hydrocortisone than the outer packaging.
0.5% or 1% p. 993 is useful for treating nappy rash and l PATIENT AND CARER ADVICE Patients or carers should be
hydrocortisone 1% for atopic eczema in childhood. A given advice on how to administer corticosteroid creams
moderately potent or potent corticosteroid may be and ointments. If a patient is using topical corticosteroids
appropriate for severe atopic eczema on the limbs, for of different potencies, the patient should be told when to
1–2 weeks only, switching to a less potent preparation as use each corticosteroid. Patients and their carers should
the condition improves. In an acute flare-up of atopic be reassured that side effects such as skin thinning and
eczema, it may be appropriate to use more potent systemic effects rarely occur when topical corticosteroids
formulations of topical corticosteroids for a short period to are used appropriately.
regain control of the condition. A very potent corticosteroid
should be initiated under the supervision of a specialist.
Continuous daily application of a mild corticosteroid such
as hydrocortisone 1% is equivalent to a potent Alclometasone dipropionate F
corticosteroid such as betamethasone 0.1% p. 993 applied
INDICATIONS AND DOSE
intermittently. Carers of young children should be advised
that treatment should not necessarily be reserved to ‘treat Inflammatory skin disorders such as eczemas
only the worst areas’ and they may need to be advised that TO THE SKIN
patient information leaflets may contain inappropriate ▶ Child: Apply 1–2 times a day, to be applied thinly
advice for the patient’s condition. ▶ Adult: Apply 1–2 times a day, to be applied thinly
 BNF 70
Potency
Alclometasone dipropionate cream 0.05%: moderate
l PATIENT AND CARER ADVICE Patients or carers should be
counselled on the application of alclometasone
dipropionate cream.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol, propylene glycol
▶ ALCLOMETASONE DIPROPIONATE (Non-proprietary)
Alclometasone dipropionate 500 microgram per 1 gram |
15 gram p no price available
▶ Modrasone (Teva UK Ltd)
Alclometasone dipropionate 500 microgram per 1
gram Modrasone 0.05% cream | 50 gram P £2.68 DT price =
£2.68
Beclometasone dipropionate
(Beclomethasone dipropionate)
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child 1–17 years: Apply 1–2 times a day, thin layer to be
applied
▶ Adult: Apply 1–2 times a day, thin layer to be applied
Potency
Beclometasone dipropionate cream and ointment
0.025%: potent.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: cream, ointment
Cream
CAUTIONARY AND ADVISORY LABELS 28
▶ BECLOMETASONE DIPROPIONATE (Non-proprietary)
Beclometasone dipropionate 250 microgram per 1
gram Beclometasone 0.025% cream | 30 gram P £68.00
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ BECLOMETASONE DIPROPIONATE (Non-proprietary)
Beclometasone dipropionate 250 microgram per 1
gram Beclometasone 0.025% ointment | 30 gram P £68.00 DT
price = £68.00
Betamethasone
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child: Apply 1–2 times a day, to be applied thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
Potency
Betamethasone valerate 0.025% cream and ointment:
moderate.
Betamethasone valerate 0.1% cream, lotion, medicated
plasters, ointment, and scalp application: potent.
Betamethasone valerate 0.12% foam: potent.
Betamethasone dipropionate 0.05% cream, lotion, and
ointment: potent.
l UNLICENSED USE Betacap ®, Betnovate ® and Betnovate-
RD ® are not licensed for use in children under 1 year.
Eczema and psoriasis 1023
Bettamousse ® is not licensed for use in children under 6
years.
l CAUTIONS Use of more than 100 g per week of 0.1%
preparation likely to cause adrenal suppression
l PATIENT AND CARER ADVICE Patient counselling is advised
for betamethasone cream, ointment, scalp application
and foam (application).
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: cream, ointment
Foam
CAUTIONARY AND ADVISORY LABELS 28, 15
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates, propylene glycol
▶ Bettamousse (Focus Pharmaceuticals Ltd)
Betamethasone (as Betamethasone valerate) 1 mg per 1
gram Bettamousse 0.1% cutaneous foam | 100 gram P £9.75
13
DT price = £9.75
Skin
Liquid
CAUTIONARY AND ADVISORY LABELS 15, 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
F stearyl alcohol), hydroxybenzoates (parabens)
▶ Betacap (Dermal Laboratories Ltd)
Betamethasone (as Betamethasone valerate) 1 mg per 1
gram Betacap 0.1% scalp application | 100 ml P £3.19 DT price
= £3.19
▶ Betnovate (GlaxoSmithKline UK Ltd)
Betamethasone (as Betamethasone valerate) 1 mg per 1
gram Betnovate 0.1% scalp application | 100 ml P £4.99 DT
price = £3.19
Betnovate 0.1% lotion | 100 ml P £4.58 DT price = £4.58
▶ Diprosone (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate) 500
microgram per 1 ml Diprosone 0.05% lotion | 30 ml P £2.73
DT price = £2.73 | 100 ml P £7.80 DT price = £7.80
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol
▶ BETAMETHASONE (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per 1
gram Betamethasone valerate 0.1% cream | 30 gram P £5.99
DT price = £3.39 | 100 gram P £11.99 DT price = £11.30
▶ Betnovate (GlaxoSmithKline UK Ltd)
Betamethasone (as Betamethasone valerate) 250 microgram
per 1 gram Betnovate RD 0.025% cream | 100 gram P £3.15
DT price = £3.15
Betamethasone (as Betamethasone valerate) 1 mg per 1
gram Betnovate 0.1% cream | 30 gram P £1.43 DT price =
£3.39 | 100 gram P £4.05 DT price = £11.30
▶ Diprosone (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate) 500
microgram per 1 gram Diprosone 0.05% cream | 30 gram P
£2.16 DT price = £2.16 | 100 gram P £6.12 DT price = £6.12
▶ Brands may include Audavate RD 0.025% cream
F Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ BETAMETHASONE (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per 1
gram Betamethasone valerate 0.1% ointment | 30 gram P
£5.55 DT price = £2.88 | 100 gram P £14.99 DT price = £9.60
▶ Betnovate (GlaxoSmithKline UK Ltd)
Betamethasone (as Betamethasone valerate) 250 microgram
per 1 gram Betnovate RD 0.025% ointment | 100 gram P £3.15
DT price = £3.15
Betamethasone (as Betamethasone valerate) 1 mg per 1
gram Betnovate 0.1% ointment | 30 gram P £1.43 DT price =
£2.88 | 100 gram P £4.05 DT price = £9.60
▶ Diprosone (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate) 500
microgram per 1 gram Diprosone 0.05% ointment |
30 gram P £2.16 DT price = £2.16 | 100 gram P £6.12 DT
price = £6.12
▶ Brands may include Audavate
 1024 Inflammatory skin conditions
Betamethasone with clioquinol
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, betamethasone p. 993.
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child 1–17 years: (consult product literature)
▶ Adult: (consult product literature)
Potency
Betamethasone (as valerate) 0.1% with clioquinol cream
and ointment: potent.
l PATIENT AND CARER ADVICE Stains clothing. Patients or
13 carers should be counselled on application of
betamethasone with clioquinol preparations.
Skin
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol
▶ BETAMETHASONE WITH CLIOQUINOL (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per 1 gram,
Clioquinol 30 mg per 1 gram Betamethasone valerate 0.1% /
Clioquinol 3% cream | 30 gram P £18.88 DT price = £18.88
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ BETAMETHASONE WITH CLIOQUINOL (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per 1 gram,
Clioquinol 30 mg per 1 gram Betamethasone valerate 0.1% /
Clioquinol 3% ointment | 30 gram P £18.88 DT price = £18.88
Betamethasone with clotrimazole
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, betamethasone p. 993, clotrimazole p. 1010.
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child 12–17 years: (consult product literature)
▶ Adult: (consult product literature)
Potency
Betamethasone dipropionate 0.064% (=betamethasone
0.5%) with clotrimazole cream: potent.
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer betamethasone with
clotrimazole cream.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), propylene glycol
▶ Lotriderm (Teva UK Ltd)
Betamethasone dipropionate 640 microgram per 1 gram,
Clotrimazole 10 mg per 1 gram Lotriderm cream | 30 gram P CAUTIONARY AND ADVISORY LABELS 28
£6.34 DT price = £6.34
BNF 70
Betamethasone with fusidic acid
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, betamethasone p. 993, fusidic acid p. 956.
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child 6–17 years: (consult product literature)
▶ Adult: (consult product literature)
Potency
Betamethasone (as valerate) 0.1% with fusidic acid
cream: potent.
l PATIENT AND CARER ADVICE Patients or carers should be
counselled on application of betamethasone with fusidic
acid preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol, hydroxybenzoates (parabens)
▶ Fucibet (LEO Pharma)
Betamethasone (as Betamethasone valerate) 1 mg per 1 gram,
Fusidic acid 20 mg per 1 gram Fucibet cream | 30 gram P
£6.38 DT price = £6.38 | 60 gram P £12.75 DT price = £12.75
Fucibet Lipid cream | 30 gram P £6.74 DT price = £6.38
Betamethasone with neomycin
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, betamethasone p. 993, neomycin sulfate p. 1009.
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN USING OINTMENT OR TO THE SKIN USING CREAM
▶ Child 2–17 years: Apply 1–2 times a day, to be applied
thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
Potency
Betamethasone (as valerate) 0.1% with neomycin cream
and ointment: potent.
l PATIENT AND CARER ADVICE Patient counselling is advised
for betamethasone with neomycin cream and ointment
(application).
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol
▶ BETAMETHASONE WITH NEOMYCIN (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per 1 gram,
Neomycin sulfate 5 mg per 1 gram Betamethasone valerate 0.1% /
Neomycin 0.5% cream | 30 gram P £18.88 DT price = £18.88 |
100 gram P £38.00 DT price = £38.00
Ointment
▶ BETAMETHASONE WITH NEOMYCIN (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per 1 gram,
Neomycin sulfate 5 mg per 1 gram Betamethasone valerate 0.1% /
Neomycin 0.5% ointment | 30 gram P £18.88 DT price = £18.88 |
100 gram P £38.00 DT price = £38.00
 BNF 70
Betamethasone with salicylic acid
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, betamethasone p. 993, salicylic acid p. 1057.
INDICATIONS AND DOSE
DIPROSALIC ® OINTMENT
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child: Apply 1–2 times a day, max. 60 g per week
▶ Adult: Apply 1–2 times a day, max. 60 g per week
Potency
Betamethasone (as dipropionate) 0.05% with salicylic
acid 3%: potent.
DIPROSALIC ® SCALP APPLICATION
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child: Apply 1–2 times a day, apply a few drops
▶ Adult: Apply 1–2 times a day, apply a few drops
Potency
Betamethasone (as dipropionate) 0.05% with salicylic
acid 2%: potent.
l PATIENT AND CARER ADVICE Patients or carers should be
counselled on application of betamethasone and salicylic
acid preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment
Liquid
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Disodium edetate
▶ Diprosalic (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate) 500
microgram per 1 ml, Salicylic acid 20 mg per 1 ml Diprosalic
0.05%/2% scalp application | 100 ml P £10.10 DT price = £10.10
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ Diprosalic (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate) 500
microgram per 1 gram, Salicylic acid 30 mg per 1
gram Diprosalic 0.05%/3% ointment | 30 gram P £3.18 DT price
= £3.18 | 100 gram P £9.14 DT price = £9.14
Clobetasol propionate F CAUTIONARY AND ADVISORY LABELS 28
INDICATIONS AND DOSE
Short-term treatment only of severe resistant inflammatory
skin disorders such as recalcitrant eczemas unresponsive
to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child: Apply 1–2 times a day for up to 4 weeks, to be
applied thinly
▶ Adult: Apply 1–2 times a day for up to 4 weeks, to be
applied thinly, maximum 50 g of 0.05% preparation
per week
Potency
Clobetasol propionate 0.05% cream, foam, ointment,
scalp application, and shampoo: very potent.
ETRIVEX ®
Moderate scalp psoriasis
TO THE SKIN
▶ Adult: Apply once daily maximum duration of
treatment 4 weeks, to be applied thinly then rinsed off
after 15 minutes; frequency of application should be
reduced after clinical improvement
Eczema and psoriasis 1025
UNLICENSED USE Dermovate ® not licensed for use in
l
children under 1 year.
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer clobetasol propionate
foam, liquid (scalp application), cream, ointment and
shampoo.
Scalp application Patients or carers should be advised to
apply foam directly to scalp lesions (foam begins to subside
immediately on contact with skin).
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: cream, ointment
Foam
CAUTIONARY AND ADVISORY LABELS 15, 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates, propylene glycol
▶ Clarelux (Pierre Fabre Dermo-Cosmetique) 13
Clobetasol propionate 500 microgram per 1 gram Clarelux
Skin
500micrograms/g foam | 100 gram P £11.06
Liquid
CAUTIONARY AND ADVISORY LABELS 15, 28
▶ Dermovate (GlaxoSmithKline UK Ltd)
Clobetasol propionate 500 microgram per 1 gram Dermovate
0.05% scalp application | 30 ml P £3.07 DT price = £3.07 |
100 ml P £10.42 DT price = £10.42
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Beeswax, cetostearyl alcohol (including cetyl
and stearyl alcohol), chlorocresol, propylene glycol
▶ CLOBETASOL PROPIONATE (Non-proprietary)
Clobetasol propionate 500 microgram per 1 gram Clobetasol
0.05% cream | 30 gram P no price available DT price = £2.69 |
100 gram P no price available DT price = £7.90
▶ Dermovate (GlaxoSmithKline UK Ltd)
Clobetasol propionate 500 microgram per 1 gram Dermovate
0.05% cream | 30 gram P £2.69 DT price = £2.69 |
100 gram P £7.90 DT price = £7.90
▶ Brands may include ClobaDerm 0.05% cream
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Propylene glycol
▶ CLOBETASOL PROPIONATE (Non-proprietary)
Clobetasol propionate 500 microgram per 1 gram Clobetasol
0.05% ointment | 30 gram P no price available DT price =
£2.69 | 100 gram P no price available DT price = £7.90
▶ Dermovate (GlaxoSmithKline UK Ltd)
Clobetasol propionate 500 microgram per 1 gram Dermovate
0.05% ointment | 30 gram P £2.69 DT price = £2.69 |
100 gram P £7.90 DT price = £7.90
▶ Brands may include ClobaDerm 0.05% ointment
Shampoo
▶ Etrivex (Galderma (UK) Ltd)
Clobetasol propionate 500 microgram per 1 gram Etrivex
500micrograms/g shampoo | 125 ml P £10.29 DT price = £10.29
Clobetasol propionate with neomycin
sulfate and nystatin
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, clobetasol propionate above, neomycin sulfate
p. 1009.
INDICATIONS AND DOSE
Short-term treatment only of severe resistant inflammatory
skin disorders such as recalcitrant eczemas associated
with infection and unresponsive to less potent
corticosteroids | Psoriasis associated with infection
TO THE SKIN
▶ Adult: (consult product literature) continued →
 1026 Inflammatory skin conditions
Potency
Clobetasol propionate 0.05% with neomycin sulfate and
nystatin cream and ointment: very potent.
l PATIENT AND CARER ADVICE Patients or carers should be
advised on application of clobetasol propionate,
neomycin sulfate and nystatin containing preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
▶ CLOBETASOL PROPIONATE WITH NEOMYCIN SULFATE AND
NYSTATIN (Non-proprietary)
Clobetasol propionate 500 microgram per 1 gram, Neomycin
sulfate 5 mg per 1 gram, Nystatin 100000 unit per 1
gram Clobetasol 500microgram / Neomycin 5mg / Nystatin
13 100,000units/g cream | 30 gram P £64.00
Ointment
Skin
CAUTIONARY AND ADVISORY LABELS 28
▶ CLOBETASOL PROPIONATE WITH NEOMYCIN SULFATE AND
NYSTATIN (Non-proprietary)
Clobetasol propionate 500 microgram per 1 gram, Neomycin
sulfate 5 mg per 1 gram, Nystatin 100000 unit per 1
gram Clobetasol 500microgram / Neomycin 5mg / Nystatin
100,000units/g ointment | 30 gram P £64.00
Clobetasone butyrate
INDICATIONS AND DOSE
Eczemas and dermatitis of all types | Maintenance between
courses of more potent corticosteroids
TO THE SKIN
▶ Child: Apply 1–2 times a day, to be applied thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
Potency
Clobetasone butyrate 0.05% cream and ointment:
moderate.
l PATIENT AND CARER ADVICE Patients or carers should be
advised on the application of clobetasone butyrate
containing preparations.
l EXCEPTIONS TO LEGAL CATEGORY Cream can be sold to
the public for short-term symptomatic treatment and
control of patches of eczema and dermatitis (but not
seborrhoeic dermatitis) in adults and children over 12
years provided pack does not contain more than 15 g.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol
▶ Eumovate (GlaxoSmithKline Consumer Healthcare, GlaxoSmithKline
UK Ltd)
Clobetasone butyrate 500 microgram per 1 gram Eumovate
Eczema and Dermatitis 0.05% cream | 15 gram p £3.57 DT price =
£3.57
Eumovate 0.05% cream | 30 gram P £1.86 DT price = £1.86 |
100 gram P £5.44 DT price = £5.44
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ Eumovate (GlaxoSmithKline UK Ltd)
Clobetasone butyrate 500 microgram per 1 gram Eumovate
0.05% ointment | 30 gram P £1.86 DT price = £1.86 |
100 gram P £5.44 DT price = £5.44
▶ Brands may include Clobavate
BNF 70
Clobetasone butyrate with nystatin and
oxytetracycline
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, clobetasone butyrate above, oxytetracycline p. 498.
INDICATIONS AND DOSE
Steroid-responsive dermatoses where candidal or bacterial
infection is present
TO THE SKIN
▶ Adult: (consult product literature)
Potency
Clobetasone butyrate 0.05% with nystatin and
oxytetracyline cream: moderate.
PATIENT AND CARER ADVICE Stains clothing.
l
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol, sodium metabisulfite
▶ Trimovate (GlaxoSmithKline UK Ltd)
Clobetasone butyrate 500 microgram per 1 gram, Nystatin
100000 unit per 1 gram, Oxytetracycline (as Oxytetracycline
calcium) 30 mg per 1 gram Trimovate cream | 30 gram P £3.29
F
Diflucortolone valerate F
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids (using 0.3%
diflucortolone valerate) | Short-term treatment of severe
exacerbations (using 0.3% diflucortolone valerate) |
Psoriasis (using 0.3% diflucortolone valerate)
TO THE SKIN
▶ Child 4–17 years: Apply 1–2 times a day for up to
2 weeks, reducing strength as condition responds, to
be applied thinly; maximum 60 g per week
▶ Adult: Apply 1–2 times a day for up to 2 weeks,
reducing strength as condition responds, to be applied
thinly; maximum 60 g per week
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids (using 0.1%
diflucortolone valerate) | Psoriasis (using 0.1%
diflucortolone valerate)
TO THE SKIN
▶ Child: Apply 1–2 times a day for up to 4 weeks, to be
applied thinly
▶ Adult: Apply 1–2 times a day for up to 4 weeks, to be
applied thinly
Potency
Diflucortolone valerate 0.1% cream and ointment:
potent.
Diflucortolone valerate 0.3% cream and ointment: very
potent.
l PRESCRIBING AND DISPENSING INFORMATION Patients or
carers should be advised on application of diflucortolone
valerate containing preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Beeswax, cetostearyl alcohol (including cetyl
and stearyl alcohol), disodium edetate, hydroxybenzoates (parabens)
 BNF 70
▶ Nerisone (Meadow Laboratories Ltd)
Diflucortolone valerate 1 mg per 1 gram Nerisone 0.1% cream |
30 gram P £1.59
Nerisone 0.1% oily cream | 30 gram P £2.56 DT price = £2.56
Diflucortolone valerate 3 mg per 1 gram Nerisone Forte 0.3% oily
cream | 15 gram P £2.09 DT price = £2.09
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ Nerisone (Meadow Laboratories Ltd)
Diflucortolone valerate 1 mg per 1 gram Nerisone 0.1%
ointment | 30 gram P £1.59
Diflucortolone valerate 3 mg per 1 gram Nerisone Forte 0.3%
ointment | 15 gram P £2.09
Fludroxycortide
(Flurandrenolone)
INDICATIONS AND DOSE
Inflammatory skin disorders such as eczemas
TO THE SKIN
▶ Child: Apply 1–2 times a day, to be applied thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
Potency
Fludroxycortide 0.0125% cream and ointment: moderate
HAELAN ® TAPE
Chronic localised recalcitrant dermatoses (but not acute or
weeping)
TO THE SKIN
▶ Child: Cut tape to fit lesion, apply to clean, dry skin
shorn of hair, usually for 12 hours daily
▶ Adult: Cut tape to fit lesion, apply to clean, dry skin
shorn of hair, usually for 12 hours daily
l PATIENT AND CARER ADVICE Patients or carers should be
counselled on application of fludroxycortide cream and
ointment.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), propylene glycol
▶ Haelan (Typharm Ltd)
Fludroxycortide 125 microgram per 1 gram Haelan 0.0125%
cream | 60 gram P £3.26
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Beeswax, cetostearyl alcohol (including cetyl
and stearyl alcohol), polysorbates
▶ Haelan (Typharm Ltd)
Fludroxycortide 125 microgram per 1 gram Haelan 0.0125%
ointment | 60 gram P £3.26
Impregnated dressing
▶ Haelan (Typharm Ltd)
Fludroxycortide 4 microgram per 1 square cm Haelan
4micrograms/square cm tape 7.5cm | 50 cm P £9.27 DT price =
£9.27 | 200 cm P £24.95 DT price = £24.95
Fluocinolone acetonide
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas |
Psoriasis
TO THE SKIN
▶ Child 1–17 years: Apply 1–2 times a day, to be applied
thinly, reduce strength as condition responds
▶ Adult: Apply 1–2 times a day, to be applied thinly,
reduce strength as condition responds
Eczema and psoriasis 1027
Potency
Fluocinolone acetonide 0.025% cream, gel, and
ointment: potent.
Fluocinolone acetonide 0.00625% cream and ointment:
moderate.
Fluocinolone acetonide 0.0025% cream: mild.
l PRESCRIBING AND DISPENSING INFORMATION Gel is useful
for application to the scalp and other hairy areas.
l PATIENT AND CARER ADVICE Patient counselling is advised
for fluocinolone acetonide cream, gel and ointment
(application).
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
F containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
13
cetyl and stearyl alcohol), polysorbates, propylene glycol
Skin
▶ Synalar (Derma UK Ltd)
Fluocinolone acetonide 25 microgram per 1 gram Synalar 1 in 10
Dilution 0.0025% cream | 50 gram P £4.58 DT price = £4.58
Fluocinolone acetonide 62.5 microgram per 1 gram Synalar 1 in
4 Dilution 0.00625% cream | 50 gram P £4.84 DT price = £4.84
Fluocinolone acetonide 250 microgram per 1 gram Synalar
0.025% cream | 30 gram P £4.14 DT price = £4.14 |
100 gram P £11.75 DT price = £11.75
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Propylene glycol, wool fat and related
substances including lanolin
▶ Synalar (Derma UK Ltd)
Fluocinolone acetonide 62.5 microgram per 1 gram Synalar 1 in
4 Dilution 0.00625% ointment | 50 gram P £4.84 DT price = £4.84
Fluocinolone acetonide 250 microgram per 1 gram Synalar
0.025% ointment | 30 gram P £4.14 DT price = £4.14 |
100 gram P £11.75 DT price = £11.75
Gel
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Hydroxybenzoates (parabens), propylene
glycol
▶ Synalar (Derma UK Ltd)
Fluocinolone acetonide 250 microgram per 1 gram Synalar
0.025% gel | 30 gram P £5.56 DT price = £5.56 | 60 gram P
£10.02 DT price = £10.02
Fluocinolone acetonide with clioquinol
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, fluocinolone acetonide above.
INDICATIONS AND DOSE
Inflammatory skin disorders such as eczemas associated
with infection | Psoriasis associated with infection
TO THE SKIN
▶ Adult: Apply 1–2 times a day, to be applied thinly,
reducing strength as condition responds
Potency
Clioquinol 3% with fluocinolone acetonide 0.025%
cream and ointment: potent
F l PATIENT AND CARER ADVICE Patient counselling is advised
for clioquinol with fluocinolone acetonide cream and
ointment (application). Ointment stains clothing.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), disodium edetate, hydroxybenzoates (parabens),
polysorbates, propylene glycol
 1028 Inflammatory skin conditions BNF 70

▶ Synalar C (Derma UK Ltd) Cream

Clioquinol 30 mg per 1 gram, Fluocinolone acetonide 250 CAUTIONARY AND ADVISORY LABELS 28
microgram per 1 gram Synalar C cream | 15 gram P £2.66 EXCIPIENTS: May contain Propylene glycol
Ointment ▶ Metosyn FAPG (Derma UK Ltd)
CAUTIONARY AND ADVISORY LABELS 28 Fluocinonide 500 microgram per 1 gram Metosyn FAPG 0.05%
EXCIPIENTS: May contain Propylene glycol, wool fat and related cream | 25 gram P £3.96 DT price = £3.96 | 100 gram P
substances including lanolin £13.34 DT price = £13.34
▶ Synalar C (Derma UK Ltd) Ointment
Clioquinol 30 mg per 1 gram, Fluocinolone acetonide 250 CAUTIONARY AND ADVISORY LABELS 28
microgram per 1 gram Synalar C ointment | 15 gram P £2.66 EXCIPIENTS: May contain Propylene glycol, wool fat and related
substances including lanolin
▶ Metosyn (Derma UK Ltd)
Fluocinonide 500 microgram per 1 gram Metosyn 0.05%
Fluocinolone acetonide with neomycin ointment | 25 gram P £3.50 DT price = £3.50 | 100 gram P
The properties listed below are those particular to the £13.15 DT price = £13.15
combination only. For the properties of the components please
consider, fluocinolone acetonide p. 1027, neomycin sulfate
p. 1009.
Fluocortolone F
13 INDICATIONS AND DOSE
INDICATIONS AND DOSE
Inflammatory skin disorders such as eczemas associated
Skin

Severe inflammatory skin disorders such as eczemas

with infection | Psoriasis associated with infection
TO THE SKIN
▶ Child 1–17 years: Apply 1–2 times a day, to be applied
thinly, reducing strength as condition responds
▶ Adult: Apply 1–2 times a day, to be applied thinly,
reducing strength as condition responds
Potency
Fluocinolone acetonide 0.025% with neomycin 0.5%
cream and ointment: potent.
l PATIENT AND CARER ADVICE Patients or carers should be
counselled on the application of fluocinolone acetonide
with neomycin preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens), polysorbates, propylene
glycol
▶ Synalar N (Derma UK Ltd)
Fluocinolone acetonide 250 microgram per 1 gram, Neomycin
sulfate 5 mg per 1 gram Synalar N cream | 30 gram P £4.36
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Propylene glycol, wool fat and related
substances including lanolin
▶ Synalar N (Derma UK Ltd)
Fluocinolone acetonide 250 microgram per 1 gram, Neomycin
sulfate 5 mg per 1 gram Synalar N ointment | 30 gram P £4.36
Fluocinonide
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Adult: Apply 1–2 times a day, to be applied thinly,
reducing strength as condition responds
Potency
Fluocortolone hexanoate 0.25% cream and ointment;
fluocortolone pivalate 0.25% cream and fluocortolone
0.25% ointment: moderate.
l PRESCRIBING AND DISPENSING INFORMATION Patients or
carers should be counselled on the application of
fluocortolone preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), disodium edetate, fragrances, hydroxybenzoates
(parabens)
▶ Ultralanum Plain (Fluocortolone hexanoate / Fluocortolone
pivalate) (Meadow Laboratories Ltd)
Fluocortolone hexanoate 2.5 mg per 1 gram, Fluocortolone
pivalate 2.5 mg per 1 gram Ultralanum Plain cream |
50 gram P £2.95
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Fragrances, wool fat and related substances
including lanolin
▶ Ultralanum Plain (Fluocortolone / Fluocortolone hexanoate)
(Meadow Laboratories Ltd)
Fluocortolone 2.5 mg per 1 gram, Fluocortolone hexanoate
2.5 mg per 1 gram Ultralanum Plain ointment | 50 gram P
F £2.95

INDICATIONS AND DOSE

Severe inflammatory skin disorders such as eczemas Fluticasone F
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN INDICATIONS AND DOSE
▶ Child 1–17 years: Apply 1–2 times a day, to be applied Severe inflammatory skin disorders such as dermatitis and
thinly eczemas unresponsive to less potent corticosteroids |
▶ Adult: Apply 1–2 times a day, to be applied thinly Psoriasis
Potency TO THE SKIN
Fluocinonide 0.05% cream and ointment: potent. ▶ Child 3 months–17 years: Apply 1–2 times a day, to be
applied thinly
l PATIENT AND CARER ADVICE Patients or carers should be ▶ Adult: Apply 1–2 times a day, to be applied thinly
advised on the application of fluocinonide preparations. Potency
Fluticasone cream 0.05%: potent.
l MEDICINAL FORMS Fluticasone ointment 0.005%: potent.
There can be variation in the licensing of different medicines
containing the same drug.
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on application of fluticasone creams and
ointments.
 BNF 70 Eczema and psoriasis 1029

l MEDICINAL FORMS ▶ HYDROCORTISONE (Non-proprietary)

There can be variation in the licensing of different medicines Hydrocortisone 5 mg per 1 gram Hydrocortisone 0.5% cream |
containing the same drug. 15 gram P £4.80 DT price = £1.42 | 30 gram P £2.84–£4.90
Cream Hydrocortisone 10 mg per 1 gram Hydrocortisone 1% cream |
CAUTIONARY AND ADVISORY LABELS 28 15 gram P £11.41 DT price = £1.15 | 15 gram p £1.64 DT price =
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
£1.15 | 30 gram P £14.30 DT price = £2.30 | 50 gram P
stearyl alcohol), imidurea, propylene glycol £27.75 DT price = £3.83
▶ Cutivate (GlaxoSmithKline UK Ltd) Hydrocortisone 25 mg per 1 gram Hydrocortisone 2.5% cream |
15 gram P £41.90 DT price = £7.05 | 30 gram P £44.00
Fluticasone propionate 500 microgram per 1 gram Cutivate
▶ Dioderm (Dermal laboratories Ltd)
0.05% cream | 15 gram P £2.27 DT price = £2.27 |
30 gram P £4.24 DT price = £4.24 Hydrocortisone 1 mg per 1 gram Dioderm 0.1% cream |
30 gram P £2.03 DT price = £2.03
Ointment ▶ Mildison Lipocream CAstellas Pharma Ltd)
CAUTIONARY AND ADVISORY LABELS 28
Hydrocortisone 10 mg per 1 gram Mildison Lipocream 1% cream |
EXCIPIENTS: May contain Propylene glycol
30 gram P £1.71 DT price = £2.30
▶ Cutivate (GlaxoSmithKline UK Ltd) ▶ Brands may include Derma Care Hydrocortisone, Dermacort, Hc45,
Fluticasone propionate 50 microgram per 1 gram Cutivate Zenoxone
0.005% ointment | 15 gram P £2.27 DT price = £2.27 |
30 gram P £4.24 DT price = £4.24 Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ HYDROCORTISONE (Non-proprietary) 13
Hydrocortisone 5 mg per 1 gram Hydrocortisone 0.5% ointment |
Hydrocortisone

Skin
F 15 gram P £4.95 DT price = £4.80 | 30 gram P £9.60–£12.00
Hydrocortisone 10 mg per 1 gram Hydrocortisone 1% ointment |
INDICATIONS AND DOSE 15 gram P £11.41 DT price = £1.26 | 30 gram p £3.31 DT price =
Mild inflammatory skin disorders such as eczemas £2.52 | 30 gram P £14.30 DT price = £2.52 | 50 gram P
£27.75 DT price = £4.20
TO THE SKIN
Hydrocortisone 25 mg per 1 gram Hydrocortisone 2.5%
▶ Child: Apply 1–2 times a day, to be applied thinly ointment | 15 gram P £25.37 DT price = £24.36 | 30 gram P
▶ Adult: Apply 1–2 times a day, to be applied thinly £48.72
Nappy rash ▶ Brands may include Lanacort
TO THE SKIN
▶ Child
Apply as required for no more than 1 week, discontinued Hydrocortisone butyrate F
as soon as the inflammation subsides
Potency INDICATIONS AND DOSE
Hydrocortisone cream and ointment 0.5 to 2.5%: mild Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
l PRESCRIBING AND DISPENSING INFORMATION When TO THE SKIN
hydrocortisone cream or ointment is prescribed and no ▶ Child 1–17 years: Apply 1–2 times a day, to be applied
strength is stated, the 1% strength should be supplied. thinly
DIODERM ® ▶ Adult: Apply 1–2 times a day, to be applied thinly
Although Dioderm® contains only 0.1% hydrocortisone, Potency
the formulation is designed to provide a clinical activity Hydrocortisone butyrate 0.1% cream, liquid, and
comparable to that of Hydrocortisone Cream 1% BP . ointment: potent
l PATIENT AND CARER ADVICE
Medicines for children leaflet: Hydrocordisone (topical) for l PATIENT AND CARER ADVICE
eczema Medicines for children leaflet: Hydrocordisone (topical) for
www.medicinesforchildren.org.uk/ eczema
hydrocortisone-topical-for-eczema www.medicinesforchildren.org.uk/
Patient counselling is advised for hydrocortisone cream hydrocortisone-topical-for-eczema
and ointment (application). Patients or carers should be given advice on how to
administer hydrocortisone butyrate lotion, cream,
l PROFESSION SPECIFIC INFORMATION
ointment and scalp lotion.
Dental practitioners’ formulary Hydrocortisone Cream 1%
15g may be prescribed . l MEDICINAL FORMS
l EXCEPTIONS TO LEGAL CATEGORY There can be variation in the licensing of different medicines
containing the same drug.
▶ Over-the-counter hydrocortisone preparations Skin creams and
ointments containing hydrocortisone (alone or with other Liquid
CAUTIONARY AND ADVISORY LABELS 15, 28
ingredients) can be sold to the public for the treatment of EXCIPIENTS: May contain Butylated hydroxytoluene, cetostearyl alcohol
allergic contact dermatitis, irritant dermatitis, insect bite (including cetyl and stearyl alcohol), hydroxybenzoates (parabens),
reactions and mild to moderate eczema in patients over propylene glycol
10 years, to be applied sparingly over the affected area ▶ Locoid (Astellas Pharma Ltd)
1-2 times daily for max. 1 week. Over-the-counter Hydrocortisone butyrate 1 mg per 1 ml Locoid 0.1% scalp lotion |
hydrocortisone preparations should not be sold without 100 ml P £6.83 DT price = £6.83
medical advice for children under 10 years or for pregnant ▶ Locoid Crelo (Astellas Pharma Ltd)
women; they should not be sold for application to the Hydrocortisone butyrate 1 mg per 1 gram Locoid Crelo 0.1%
face, anogenital region, broken or infected skin (including topical emulsion | 100 gram P £5.91
cold sores, acne, and athlete's foot) . Cream
CAUTIONARY AND ADVISORY LABELS 28
l MEDICINAL FORMS EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), hydroxybenzoates (parabens)
Cream
▶ Locoid (Astellas Pharma Ltd)
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including Hydrocortisone butyrate 1 mg per 1 gram Locoid 0.1% cream |
cetyl and stearyl alcohol), hydroxybenzoates (parabens), propylene 30 gram P £1.60 DT price = £1.60 | 100 gram P £4.93 DT
glycol price = £4.93
 1030 Inflammatory skin conditions
▶ Locoid Lipocream (Astellas Pharma Ltd)
Hydrocortisone butyrate 1 mg per 1 gram Locoid 0.1%
Lipocream | 30 gram P £1.69 DT price = £1.60 | 100 gram P EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
£5.17 DT price = £4.93
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ Locoid (Astellas Pharma Ltd)
Hydrocortisone butyrate 1 mg per 1 gram Locoid 0.1%
ointment | 30 gram P £1.60 DT price = £1.60 | 100 gram P Ointment
£4.93 DT price = £4.93
Hydrocortisone with benzalkonium
chloride, dimeticone and nystatin
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, dimeticone p. 1014, hydrocortisone p. 993.
13
INDICATIONS AND DOSE
Skin
Mild inflammatory skin disorders such as eczemas
TO THE SKIN
▶ Child: Apply 1–2 times a day, to be applied thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
Potency
Benzalkonium with dimeticone, hydrocortisone acetate
1%, and nystatin cream: mild.
l PATIENT AND CARER ADVICE Patients or carers should be
advised on application of benzalkonium with dimeticone
and hydrocortisone and nystatin preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxyanisole, cetostearyl alcohol
(including cetyl and stearyl alcohol), hydroxybenzoates (parabens),
sodium metabisulfite, sorbic acid
▶ Timodine (Alliance Pharmaceuticals Ltd)
Benzalkonium chloride 1 mg per 1 gram, Dimeticone 350 100 mg
per 1 gram, Hydrocortisone 5 mg per 1 gram, Nystatin 100000
unit per 1 gram Timodine cream | 30 gram P £2.86
Hydrocortisone with chlorhexidine
hydrochloride and nystatin
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, chlorhexidine p. 989, hydrocortisone p. 993.
INDICATIONS AND DOSE
Mild inflammatory skin disorders such as eczemas
TO THE SKIN
▶ Child: To be applied thinly (consult product literature)
▶ Adult: To be applied thinly (consult product literature)
Potency
Chlorhexidine hydrochloride 1% with hydrocortisone
0.5% and nystatin cream: mild
Chlorhexidine hydrochloride 1% with hydrocortisone 1%
and nystatin ointment: mild
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on application of chlorhexidine
hydrochloride with hydrocortisone and nystatin
preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
BNF 70
Cream
CAUTIONARY AND ADVISORY LABELS 28
cetyl and stearyl alcohol), polysorbates
▶ Nystaform HC (Typharm Ltd)
Chlorhexidine hydrochloride 10 mg per 1 gram, Hydrocortisone
5 mg per 1 gram, Nystatin 100000 iu per 1 gram Nystaform HC
cream | 30 gram P £2.66
CAUTIONARY AND ADVISORY LABELS 28
▶ Nystaform HC (Typharm Ltd)
Chlorhexidine acetate 10 mg per 1 gram, Hydrocortisone 10 mg
per 1 gram, Nystatin 100000 unit per 1 gram Nystaform HC
ointment | 30 gram P £2.66
Hydrocortisone with clotrimazole
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, clotrimazole p. 1010, hydrocortisone p. 993.
INDICATIONS AND DOSE
Mild inflammatory skin disorders such as eczemas
(associated with fungal infection)
TO THE SKIN
▶ Child: (consult product literature)
▶ Adult: (consult product literature)
Potency
Clotrimazole with hydrocortisone 1% cream: mild
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer clotrimazole with
hydrocortisone cream.
l EXCEPTIONS TO LEGAL CATEGORY A 15-g tube is on sale to
the public for the treatment of athlete’s foot and fungal
infection of skin folds with associated inflammation in
patients 10 years and over.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol)
▶ Canesten HC (Bayer Plc)
Clotrimazole 10 mg per 1 gram, Hydrocortisone 10 mg per 1
gram Canesten HC cream | 30 gram P £2.42 DT price = £2.42
▶ Brands may include Canesten Hydrocortisone cream
Hydrocortisone with fusidic acid
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, fusidic acid p. 956, hydrocortisone p. 993.
INDICATIONS AND DOSE
Mild inflammatory skin disorders such as eczemas
TO THE SKIN
▶ Child: To be applied thinly (consult product literature)
▶ Adult: To be applied thinly (consult product literature)
Potency
Hydrocortisone with fusidic acid cream: mild
l PATIENT AND CARER ADVICE Patients or carers should be
advised on application of hydrocortisone with fusidic acid
preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
 BNF 70
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxyanisole, cetostearyl alcohol
(including cetyl and stearyl alcohol), polysorbates, potassium sorbate
▶ Fucidin H (Fusidic acid / Hydrocortisone) (LEO Pharma)
Fusidic acid 20 mg per 1 gram, Hydrocortisone acetate 10 mg
per 1 gram Fucidin H cream | 30 gram P £5.02 DT price =
£5.02 | 60 gram P £10.04 DT price = £10.04
Hydrocortisone with miconazole
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, hydrocortisone p. 993, miconazole p. 1011.
INDICATIONS AND DOSE
Mild inflammatory skin disorders such as eczemas
associated with infections
TO THE SKIN
Adult: (consult product literature)
▶
Potency
Hydrocortisone 1% with miconazole cream and
ointment: mild
l INTERACTIONS → Appendix 1 (antifungals, imidazole).
l PATIENT AND CARER ADVICE Patients or carers should be
advised on application of hydrocortisone with miconazole
preparations.
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
May be prescribed as Miconazole and Hydrocortisone
Cream or Ointment for max. 7 days.
l EXCEPTIONS TO LEGAL CATEGORY A 15-g tube of
hydrocortisone with miconazole cream is on sale to the
public for the treatment of athlete’s foot and candidal
intertrigo.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxyanisole, disodium edetate
▶ Daktacort (McNeil Products Ltd, Janssen-Cilag Ltd)
Hydrocortisone 10 mg per 1 gram, Miconazole nitrate 20 mg per
1 gram Daktacort Hydrocortisone cream | 15 gram p £3.17 DT
price = £3.17
Daktacort 2%/1% cream | 30 gram P £2.49 DT price = £2.49
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ Daktacort (Janssen-Cilag Ltd)
Hydrocortisone 10 mg per 1 gram, Miconazole nitrate 20 mg per
1 gram Daktacort ointment | 30 gram P £2.50 DT price = £2.50
Hydrocortisone with oxytetracycline
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, hydrocortisone p. 993, oxytetracycline p. 498.
INDICATIONS AND DOSE
Mild inflammatory skin disorders such as eczemas
TO THE SKIN
▶ Child 12–17 years: (consult product literature)
▶ Adult: (consult product literature)
Potency
Hydrocortisone 1% with oxytetracycline ointment: mild.
l CONTRA-INDICATIONS Children under 12 years
l PREGNANCY Tetracyclines should not be given to
pregnant women. Effects on skeletal development have
been documented when tetracyclines have been used in
the first trimester in animal studies. Administration
Eczema and psoriasis 1031
during the second or third trimester may cause
discoloration of the child’s teeth.
l BREAST FEEDING Tetracyclines should not be given to
women who are breast-feeding (although absorption and
therefore discoloration of teeth in the infant is probably
usually prevented by chelation with calcium in milk).
l PATIENT AND CARER ADVICE Patients should be given
advice on the application of hydrocortisone with
oxytetracycline ointment.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ Terra-Cortril (Intrapharm Laboratories Ltd)
Hydrocortisone 10 mg per 1 gram, Oxytetracycline (as
Oxytetracycline hydrochloride) 30 mg per 1 gram Terra-Cortril 13
ointment | 30 gram P £5.01
Skin
Hydrocortisone with urea
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, hydrocortisone p. 993.
INDICATIONS AND DOSE
Mild inflammatory skin disorders such as eczemas
TO THE SKIN
▶ Child: To be applied thinly (consult product literature)
▶ Adult: To be applied thinly (consult product literature)
Potency
Hydrocortisone 1% with urea cream: moderate
l PATIENT AND CARER ADVICE Patients or carers should be
advised on application of hydrocortisone with urea cream.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 28
▶ Alphaderm (Alliance Pharmaceuticals Ltd)
Hydrocortisone 10 mg per 1 gram, Urea 100 mg per 1
gram Alphaderm 1%/10% cream | 30 gram P £2.38 DT price =
£2.38 | 100 gram P £7.03 DT price = £7.03
Mometasone furoate F
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
TO THE SKIN
▶ Child 2–17 years: Apply once daily, to be applied thinly
(to scalp in case of lotion)
▶ Adult: Apply once daily, to be applied thinly (to scalp
in case of lotion)
Potency
Mometasone furoate 0.1% cream, ointment, and scalp
lotion: potent.
l PATIENT AND CARER ADVICE Patients and carers should be
advised on the application of topical mometasone.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment
 1032 Inflammatory skin conditions
Liquid
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Propylene glycol
▶ Elocon (Merck Sharp & Dohme Ltd)
Mometasone furoate 1 mg per 1 gram Elocon 0.1% scalp lotion |
30 ml P £4.36 DT price = £4.36
Cream
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Beeswax
▶ MOMETASONE FUROATE (Non-proprietary)
Mometasone furoate 1 mg per 1 gram Mometasone 0.1% cream |
30 gram P £4.36 DT price = £4.23 | 100 gram P £14.47 DT
price = £14.10
▶ Elocon (Merck Sharp & Dohme Ltd)
Mometasone furoate 1 mg per 1 gram Elocon 0.1% cream |
30 gram P £4.36 DT price = £4.23 | 100 gram P £12.58 DT
price = £14.10
Ointment
13 CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Beeswax, propylene glycol
▶ MOMETASONE FUROATE (Non-proprietary)
Skin
Mometasone furoate 1 mg per 1 gram Mometasone 0.1%
ointment | 15 gram P £4.32 | 30 gram P £4.45 DT price =
£3.63 | 50 gram P £12.44 | 100 gram P £12.82 DT price =
£12.10
▶ Elocon (Merck Sharp & Dohme Ltd)
Mometasone furoate 1 mg per 1 gram Elocon 0.1% ointment |
30 gram P £4.32 DT price = £3.63 | 100 gram P £12.44 DT
price = £12.10
Triamcinolone with chlortetracycline
INDICATIONS AND DOSE
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids (associated
with infection) | Psoriasis (associated with infection)
TO THE SKIN
▶ Child 8–17 years: To be applied thinly (consult product
literature)
▶ Adult: To be applied thinly (consult product literature)
Potency
Triamcinolone acetonide 0.1%, chlortetracycline
hydrochloride 3% ointment: potent.
l PATIENT AND CARER ADVICE Stains clothing. Patients or
carers should be counselled on the application of
chlortetracycline with triamcinolone products.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Wool fat and related substances including
lanolin
▶ Aureocort (AMCo)
Chlortetracycline hydrochloride 30.9 mg per 1 gram,
Triamcinolone acetonide 1 mg per 1 gram Aureocort ointment |
15 gram P £3.51
RETINOID AND RELATED DRUGS
Acitretin
l DRUG ACTION Acitretin is a metabolite of etretinate.
INDICATIONS AND DOSE
Severe extensive psoriasis resistant to other forms of
therapy | Palmoplantar pustular psoriasis | Severe
congenital ichthyosis (under expert supervision)
BY MOUTH
▶ Adult: Initially 25–30 mg daily for 2–4 weeks, then
adjusted according to response to 25–50 mg daily,
increased to up to 75 mg daily, dose only increased to
75 mg daily for short periods in psoriasis
BNF 70
Severe Darier’s disease (keratosis follicularis) (under expert
supervision)
BY MOUTH
▶ Adult: Initially 10 mg daily for 2–4 weeks, then
adjusted according to response to 25–50 mg daily
l CONTRA-INDICATIONS Hyperlipidaemia
l CAUTIONS Avoid excessive exposure to sunlight and
unsupervised use of sunlamps . diabetes (can alter glucose
tolerance—initial frequent blood glucose checks) . do not
donate blood during and for 2 years after stopping
therapy (teratogenic risk) . in children use only in
exceptional circumstances and monitor growth
parameters and bone development (premature epiphyseal
closure reported) . investigate atypical musculoskeletal
symptoms
l INTERACTIONS → Appendix 1 (retinoids).
Avoid concomitant use of keratolytics.
l SIDE-EFFECTS
▶ Common or very common Abdominal pain . abnormal hair
texture . alopecia (reversible on withdrawal) . arthralgia .
brittle nails . dermatitis . diarrhoea . dryness and
inflammation of mucous membranes . dryness of
conjunctiva (causing conjunctivitis and decreased
tolerance to contact lenses) . epidermal fragility .
erythema . headache . myalgia . nausea . paronychia .
peripheral oedema . pruritus . reversible increase in
serum-cholesterol (with high doses) . reversible increase
in serum-triglyceride concentrations (with high doses) .
skin exfoliation . sticky skin . vomiting
▶ Uncommon Dizziness . hepatitis . photosensitivity . visual
disturbances
▶ Rare Peripheral neuropathy
▶ Very rare Benign intracranial hypertension . bone pain .
exostosis . night blindness . ulcerative keratitis
▶ Frequency not known Drowsiness . dry skin . flushing .
granulomatous lesions . impaired hearing . initial
worsening of psoriasis . malaise . rectal haemorrhage .
sweating . taste disturbance . tinnitus
SIDE-EFFECTS, FURTHER INFORMATION
Exostosis Skeletal hyperostosis and extra-osseous
calcification reported following long-term treatment with
etretinate (of which Acitretin is a metabolite) and
premature epiphyseal closure in children.
Benign intracranial hypertension Discontinue if severe
headache, nausea, vomiting, or visual disturbances occur.
l CONCEPTION AND CONTRACEPTION Effective
contraception must be used.
Pregnancy prevention In females of child-bearing potential
(including those with a history of infertility), exclude
pregnancy up to 3 days before treatment, every month
during treatment, and every 1–3 months for 3 years after
stopping treatment. Treatment should be started on day 2 or
3 of menstrual cycle. Females of child-bearing age must
practise effective contraception for at least 1 month before
starting treatment, during treatment, and for at least 3 years
after stopping treatment. Females should be advised to use
at least 1 method of contraception, but ideally they should
use 2 methods of contraception. Oral progestogen-only
contraceptives are not considered effective. Barrier methods
should not be used alone but can be used in conjunction
with other contraceptive methods. Females should be
advised to seek medical attention immediately if they
become pregnant during treatment or within 3 years of
stopping treatment. They should also be advised to avoid
alcohol during treatment and for 2 months after stopping
treatment.
l PREGNANCY Avoid—teratogenic.
l BREAST FEEDING Avoid.
l HEPATIC IMPAIRMENT Avoid in severe impairment—risk of
further impairment.
 BNF 70
l RENAL IMPAIRMENT Avoid in severe impairment;
increased risk of toxicity.
l MONITORING REQUIREMENTS
▶ Check liver function at start, then every 2–4 weeks for
first 2 months and then every 3 months.
▶ Monitor serum-triglyceride and serum-cholesterol
concentrations before treatment, 1 month after starting,
then every 3 months.
l PRESCRIBING AND DISPENSING INFORMATION Each
prescription for acitretin should be limited to a supply of
up to 30 days’ treatment and dispensed within 7 days of
the date stated on the prescription.
l PATIENT AND CARER ADVICE A patient information leaflet
should be provided. Females of child-bearing potential
must be advised on pregnancy prevention.
MEDICINAL FORMS
l
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral solution, oral suspension
Capsule
CAUTIONARY AND ADVISORY LABELS 10, 11, 21
▶ ACITRETIN (Non-proprietary)
Acitretin 10 mg Acitretin 10mg capsules | 60 capsule P £23.80
DT price = £23.80
Acitretin 25 mg Acitretin 25mg capsules | 60 capsule P £55.24
DT price = £55.24
▶ Neotigason (Actavis UK Ltd)
Acitretin 10 mg Neotigason 10mg capsules | 60 capsule P
£17.30 DT price = £23.80 (Hospital only)
Acitretin 25 mg Neotigason 25mg capsules | 60 capsule P
£43.00 DT price = £55.24 (Hospital only)
Alitretinoin
INDICATIONS AND DOSE
Severe chronic hand eczema refractory to potent topical
corticosteroids
BY MOUTH
▶ Adult (prescribed by or under supervision of a consultant
dermatologist): 30 mg once daily; reduced if not
tolerated to 10 mg once daily for 12–24 weeks total
duration of treatment, discontinue if no response after
12 weeks, course may be repeated in those who
relapse
Severe chronic hand eczema refractory to potent topical
corticosteroids in patients with diabetes, history of
hyperlipidaemia, or risk factors for cardiovascular disease
BY MOUTH
▶ Adult (prescribed by or under supervision of a consultant
dermatologist): Initially 10 mg once daily, increased if
necessary up to 30 mg once daily for 12–24 weeks
total duration of treatment, discontinue if no response
after 12 weeks, course may be repeated in those who
relapse
l CONTRA-INDICATIONS Hypervitaminosis A . uncontrolled
hyperlipidaemia . uncontrolled hypothyroidism
l CAUTIONS Avoid blood donation during treatment and for
at least 1 month after stopping treatment . dry eye
syndrome . history of depression
l INTERACTIONS → Appendix 1 (retinoids).
l SIDE-EFFECTS
▶ Common or very common Alopecia . anaemia . arthralgia .
changes in thyroid function tests . cheilitis . conjunctivitis
. dry eyes . dryness of lips . dryness of skin . erythema . eye
irritation . flushing . headache . myalgia . raised creatine
kinase . raised serum concentration of triglycerides and of
cholesterol (risk of pancreatitis if triglycerides above
9 mmol/litre)
Eczema and psoriasis 1033
▶ Uncommon Ankylosing spondylitis . asteototic eczema .
blurred vision . cataracts . epistaxis . hyperostosis .
pruritus
▶ Rare Benign intracranial hypertension . vasculitis
▶ Frequency not known Decreased tolerance to contact
lenses . depression . impaired night vision . keratitis .
mood changes . suicidal ideation
SIDE-EFFECTS, FURTHER INFORMATION
Dry eyes Dry eyes may respond to lubricating eye
ointment or tear replacement therapy.
Benign intracranial hypertension Discontinue treatment if
severe headache, nausea, vomiting, papilloedema, or
visual disturbances occur.
l CONCEPTION AND CONTRACEPTION Effective
contraception must be used.
Pregnancy prevention In women of child-bearing potential,
exclude pregnancy 1 month before treatment, up to 3 days
before treatment, every month during treatment (unless
13
there are compelling reasons to indicate that there is no risk
Skin
of pregnancy), and 5 weeks after stopping treatment—
perform pregnancy test in the first 3 days of the menstrual
cycle. Women must practise effective contraception for at
least 1 month before starting treatment, during treatment,
and for at least 1 month after stopping treatment. Women
should be advised to use at least 1 method of contraception
but ideally they should use 2 methods of contraception. Oral
progestogen-only contraceptives are not considered
effective. Barrier methods should not be used alone but can
be used in conjunction with other contraceptive methods.
Women should be advised to discontinue treatment and to
seek prompt medical attention if they become pregnant
during treatment or within 1 month of stopping treatment.
l PREGNANCY Avoid—teratogenic.
l BREAST FEEDING Manufacturer advises avoid.
l HEPATIC IMPAIRMENT Manufacturer advises avoid—no
information available.
l RENAL IMPAIRMENT Manufacturer advises avoid in severe
impairment—no information available.
l MONITORING REQUIREMENTS Monitor serum lipids (more
frequently in those with diabetes, history of
hyperlipidaemia, or risk factors for cardiovascular
disease)—discontinue if uncontrolled hyperlipidaemia.
l PRESCRIBING AND DISPENSING INFORMATION
Prescribing for women of child-bearing potential Each
prescription for alitretinoin should be limited to a supply of
up to 30 days’ treatment and dispensed within 7 days of the
date stated on the prescription.
Alitretinoin is teratogenic and must not be given to
women of child-bearing potential unless they practise
effective contraception and then only after detailed
assessment and explanation by the physician.
l PATIENT AND CARER ADVICE Women of child-bearing
potential must be counselled on pregnancy prevention.
l NATIONAL FUNDING/ACCESS DECISIONS
NICE technology appraisals (TAs)
▶ Alitretinoin for the treatment of severe chronic hand eczema
in adults (August 2009) NICE TA177
Alitretinoin is recommended for the treatment of severe
chronic hand eczema that has not responded to potent
topical corticosteroids. Treatment should be stopped as
soon as an adequate response has been achieved (hands
clear or almost clear), or if the eczema remains severe
after 12 weeks, or if an adequate response has not been
achieved by 24 weeks. www.nice.org.uk/TA177
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
 1034 Inflammatory skin conditions
Capsule
CAUTIONARY AND ADVISORY LABELS 10, 11, 21
▶ Toctino (Stiefel Laboratories (UK) Ltd)
Alitretinoin 10 mg Toctino 10mg capsules | 30 capsule P
£411.43
Alitretinoin 30 mg Toctino 30mg capsules | 30 capsule P
£411.43
Tazarotene
INDICATIONS AND DOSE
Mild to moderate plaque psoriasis affecting up to 10% of
skin area
TO THE SKIN
▶ Adult: Apply once daily usually for up to 12 weeks,
apply in the evening
13
l CAUTIONS Avoid contact with eczematous skin . avoid
contact with eyes . avoid contact with face . avoid contact
Skin
with hair-covered scalp . avoid contact with inflamed skin
. avoid contact with intertriginous areas
l SIDE-EFFECTS
▶ Rare Dry or painful skin . stinging and inflamed skin
▶ Frequency not known Burning . contact dermatitis .
desquamation . erythema . local irritation . non-specific
rash . pruritus . worsening of psoriasis
SIDE-EFFECTS, FURTHER INFORMATION
Local irritation Local irritation is more common with
higher concentration and may require discontinuation.
l CONCEPTION AND CONTRACEPTION Effective
contraception required (oral progestogen-only
contraceptives not considered effective).
l PREGNANCY Avoid.
l BREAST FEEDING Manufacturer advises avoid—present in
milk in animal studies.
l PATIENT AND CARER ADVICE Avoid excessive exposure to
UV light (including sunlight, solariums, PUVA or UVB
treatment). Do not apply emollients or cosmetics within 1
hour of application. Wash hands immediately after use.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Gel
EXCIPIENTS: May contain Benzyl alcohol, butylated hydroxyanisole,
butylated hydroxytoluene, disodium edetate, polysorbates
▶ Zorac (Allergan Ltd)
Tazarotene 500 microgram per 1 gram Zorac 0.05% gel |
30 gram P £14.09
Tazarotene 1 mg per 1 gram Zorac 0.1% gel | 30 gram P
£14.80
SALICYLATES
Salicylic acid with zinc oxide
INDICATIONS AND DOSE
Hyperkeratotic skin disorders
TO THE SKIN
▶ Adult: Apply twice daily
l CAUTIONS Avoid broken skin . avoid inflamed skin
CAUTIONS, FURTHER INFORMATION
Salicylate toxicity Salicylate toxicity may occur particularly
if applied on large areas of skin or neonatal skin.
l SIDE-EFFECTS Excessive drying . irritation . sensitivity .
systemic effects (after widespread use)
l PRESCRIBING AND DISPENSING INFORMATION Zinc and
Salicylic Acid Paste BP is also referred to as Lassar’s Paste.
When prepared extemporaneously, the BP states Zinc and
BNF 70
Salicylic Acid Paste, BP (Lassar’s Paste), zinc oxide 24%,
salicylic acid 2%, starch 24%, white soft paraffin 50%.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment, paste
TARS
Coal tar
INDICATIONS AND DOSE
Psoriasis | Chronic atopic eczema
TO THE SKIN USING PASTE
▶ Child: Apply 1–3 times a day, start application with
low-strength preparations
▶ Adult: Apply 1–3 times a day, start application with
low-strength preparations
TO THE SKIN
▶ Child: 100 mL/bath, to be added to an adult sized bath;
add proportionally less for a child’s bath. Use Coal Tar
Solution BP
▶ Adult: 100 mL/bath, to be added to an adult sized bath;
add proportionally less for a child’s bath. Use Coal Tar
Solution BP
ALPHOSYL 2 IN 1 ® SHAMPOO
Psoriasis | Seborrhoeic dermatitis | Scaling | Itching
TO THE SKIN
▶ Adult: Apply every 2–3 days
Dandruff
TO THE SKIN
▶ Adult: Apply 1–2 times a week as required
EXOREX ® LOTION
Psoriasis
TO THE SKIN
▶ Adult: Apply 2–3 times a day, to be applied to skin or
scalp. Can be diluted with a few drops of water before
applying
l CONTRA-INDICATIONS Avoid broken or inflamed skin .
avoid eye area . avoid genital area . avoid mucosal areas .
avoid rectal area . infection . sore, acute, or pustular
psoriasis
l CAUTIONS Application to face . application to skin
flexures
l SIDE-EFFECTS Acne-like eruptions . photosensitivity . skin
irritation
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Coal Tar
Solution: BP contains coal tar 20%; Strong Coal Tar
Solution: BP contains coal tar 40%.
l HANDLING AND STORAGE Use suitable chemical protection
gloves for extemporaneous preparation. May stain skin,
hair and fabric.
l PATIENT AND CARER ADVICE May stain skin, hair and
fabric.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: paste, cream, ointment
Bath additive
▶ COAL TAR (Non-proprietary)
Coal tar distilled 400 mg per 1 ml Psoriderm Emulsion 40% bath
additive | 200 ml p £2.74
Shampoo
EXCIPIENTS: May contain Fragrances, hydroxybenzoates (parabens)
▶ COAL TAR (Non-proprietary)
Coal tar extract 20 mg per 1 gram Coal tar extract 2% shampoo |
125 ml G no price available | 250 ml G no price available
▶ Brands may include Alphosyl 2 in 1, Neutrogena T/Gel Therapeutic
 BNF 70 Eczema and psoriasis 1035

Cutaneous emulsion l MEDICINAL FORMS

EXCIPIENTS: May contain Hydroxybenzoates (parabens) There can be variation in the licensing of different medicines
▶ Exorex (Forest Laboratories UK Ltd) containing the same drug.
Coal tar solution 50 mg per 1 gram Exorex lotion | 100 ml G Shampoo
£8.11 DT price = £8.11 | 250 ml G £16.24 DT price = £16.24 ▶ Capasal (Dermal Laboratories Ltd)
Coal tar distilled 10 mg per 1 gram, Coconut oil 10 mg per 1
gram, Salicylic acid 5 mg per 1 gram Capasal Therapeutic
Coal tar with cade oil, arachis oil shampoo | 250 ml p £4.69

extract of coal tar, light liquid paraffin

Coal tar with dithranol and salicylic
and tar
The properties listed below are those particular to the
acid
combination only. For the properties of the components please The properties listed below are those particular to the
consider, coal tar p. 1034. combination only. For the properties of the components please
consider, dithranol p. 1018, salicylic acid p. 1057, coal tar
INDICATIONS AND DOSE p. 1034.
Psoriasis | Eczema | Atopic dermatoses | Pruritic dermatoses
TO THE SKIN
INDICATIONS AND DOSE 13
▶ Child: 2–4 capfuls/bath, alternatively 15–30 mL, to be Subacute and chronic psoriasis

Skin
added in an adult-size bath and soak for 20 minutes TO THE SKIN
(proportionally less for a child’s bath) ▶ Child: Apply up to twice daily
▶ Adult: 2–4 capfuls/bath, alternatively 15–30 mL, to be ▶ Adult: Apply up to twice daily
added in an adult-size bath and soak for 20 minutes
(proportionally less for a child’s bath) l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
l MEDICINAL FORMS manufacturers include: ointment
There can be variation in the licensing of different medicines
containing the same drug.
Bath additive
EXCIPIENTS: May contain Isopropyl palmitate
Coal tar with lecithin
▶ Polytar (GlaxoSmithKline Consumer Healthcare) The properties listed below are those particular to the
Arachis oil extract of crude coal tar 75 mg per 1 gram, Cade oil combination only. For the properties of the components please
consider, coal tar p. 1034.
75 mg per 1 gram, Coal tar solution 25 mg per 1 gram, Liquid
paraffin light 350 mg per 1 gram, Pine tar 75 mg per 1 INDICATIONS AND DOSE
gram Polytar Emollient | 500 ml G £5.78
PSORIDERM ® CREAM
Psoriasis
Coal tar with calamine TO THE SKIN
▶ Child: Apply 1–2 times a day, cream to be applied to
The properties listed below are those particular to the the skin or scalp
combination only. For the properties of the components please ▶ Adult: Apply 1–2 times a day, cream to be applied to
consider, coal tar p. 1034.
the skin or scalp
INDICATIONS AND DOSE PSORIDERM ® SCALP LOTION
Psoriasis | Chronic atopic eczema (occasionally) Scalp psoriasis
TO THE SKIN TO THE SKIN
▶ Adult: Apply 1–2 times a day ▶ Child: Apply as required
▶ Adult: Apply as required
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Calamine and
l MEDICINAL FORMS
Coal Tar Ointment, BP consists of calamine 12.5 g, strong There can be variation in the licensing of different medicines
coal tar solution 2.5 g, zinc oxide 12.5 g, hydrous wool fat containing the same drug.
25 g, white soft paraffin 47.5 g. Cream
EXCIPIENTS: May contain Isopropyl palmitate, propylene glycol
l MEDICINAL FORMS ▶ COAL TAR WITH LECITHIN (Non-proprietary)
There can be variation in the licensing of different medicines
Coal tar distilled 60 mg per 1 gram, Lecithin 4 mg per 1
containing the same drug. Forms available from special-order
manufacturers include: ointment gram Psoriderm cream | 225 ml p £9.42
Shampoo
EXCIPIENTS: May contain Disodium edetate
▶ COAL TAR WITH LECITHIN (Non-proprietary)
Coal tar with coconut oil and salicylic Coal tar distilled 25 mg per 1 ml, Lecithin 3 mg per 1
ml Psoriderm scalp lotion | 250 ml p £4.74
acid
The properties listed below are those particular to the
combination only. For the properties of the components please Coal tar with salicylic acid
consider, salicylic acid p. 1057, coal tar p. 1034. The properties listed below are those particular to the
combination only. For the properties of the components please
INDICATIONS AND DOSE consider, salicylic acid p. 1057, coal tar p. 1034.
Scaly scalp disorders | Psoriasis | Seborrhoeic dermatitis |
Dandruff | Cradle cap INDICATIONS AND DOSE
TO THE SKIN USING SHAMPOO Psoriasis | Chronic atopic eczema
▶ Child: Apply daily as required TO THE SKIN USING OINTMENT
▶ Adult: Apply daily as required ▶ Adult: Apply 1–2 times a day
 1036 Inflammatory skin conditions
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Coal Tar and
Salicylic Acid Ointment, BP consists of coal tar 2 g,
salicylic acid 2 g, emulsifying wax 11.4 g, white soft
paraffin 19 g, coconut oil 54 g, polysorbate ‘80’ 4 g, liquid
paraffin 7.6 g.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment, cream
Coal tar with salicylic acid and
precipitated sulfur
The properties listed below are those particular to the
13 combination only. For the properties of the components please
consider, salicylic acid p. 1057, coal tar p. 1034.
Skin
INDICATIONS AND DOSE
COCOIS ® OINTMENT
Scaly scalp disorders including psoriasis, eczema,
seborrhoeic dermatitis and dandruff
INITIALLY TO THE SKIN USING SCALP OINTMENT
▶ Child 6–11 years: Medical supervision required
▶ Child 12–17 years: Apply once weekly as required,
alternatively (to the skin) apply daily for the first
3–7 days (if severe), shampoo off after 1 hour
▶ Adult: Apply once weekly as required, alternatively (to
the skin) apply daily for the first 3–7 days (if severe),
shampoo off after 1 hour
SEBCO ® OINTMENT
Scaly scalp disorders including psoriasis, eczema,
seborrhoeic dermatitis and dandruff
INITIALLY TO THE SKIN USING SCALP OINTMENT
▶ Child 6–11 years: Medical supervision required
▶ Adult: Apply as required, alternatively (to the skin)
apply daily for the first 3–7 days (if severe), shampoo
off after 1 hour
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Ointment
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol)
▶ Cocois (Focus Pharmaceuticals Ltd)
Coal tar solution 120 mg per 1 gram, Salicylic acid 20 mg per 1
gram, Sulfur precipitated 40 mg per 1 gram Cocois ointment |
40 gram G £6.22 | 100 gram G £11.69
▶ Sebco (Derma UK Ltd)
Coal tar solution 120 mg per 1 gram, Salicylic acid 20 mg per 1
gram, Sulfur precipitated 40 mg per 1 gram Sebco ointment |
40 gram G £5.91 | 100 gram G £11.11
Coal tar with zinc oxide
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, coal tar p. 1034.
INDICATIONS AND DOSE
Psoriasis | Chronic atopic eczema
TO THE SKIN
▶ Child: Apply 1–2 times a day
Adult: Apply 1–2 times a day
▶
BNF 70
l PRESCRIBING AND DISPENSING INFORMATION No
preparations available – when prepared
extemporaneously, the BP states Zinc and Coal Tar Paste,
BP consists of zinc oxide 6%, coal tar 6%, emulsifying wax
5%, starch 38%, yellow soft paraffin 45%.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment, paste
Extract of coal tar with arachis oil
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, coal tar p. 1034.
INDICATIONS AND DOSE
Scalp disorders | Psoriasis | Seborrhoea | Eczema | Pruritus |
Dandruff
TO THE SKIN
▶ Child: Apply 1–2 times a week, to the scalp
▶ Adult: Apply 1–2 times a week, to the scalp
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Shampoo
▶ Polytar (GlaxoSmithKline Consumer Healthcare)
Arachis oil extract of crude coal tar 3 mg per 1 gram, Cade oil
3 mg per 1 gram, Coal tar solution 1 mg per 1 gram, Pine tar
3 mg per 1 gram Polytar liquid | 150 ml G £1.61 | 250 ml G
£2.23 | 500 ml G £4.40
▶ Polytar Plus (GlaxoSmithKline Consumer Healthcare)
Arachis oil extract of crude coal tar 3 mg per 1 gram, Cade oil
3 mg per 1 gram, Coal tar solution 1 mg per 1 gram, Pine tar
3 mg per 1 gram Polytar Plus liquid | 500 ml G £3.91
VITAMIN D AND ANALOGUES
Calcipotriol
INDICATIONS AND DOSE
Plaque psoriasis
TO THE SKIN USING OINTMENT
▶ Adult: Apply 1–2 times a day, when preparations are
used together maximum total calcipotriol 5 mg in any
one week (e.g. scalp solution 60 mL with ointment
30 g or scalp solution 30 mL with ointment 60 g);
maximum 100 g per week
Scalp psoriasis
TO THE SKIN USING SCALP LOTION
▶ Adult: Apply twice daily, when preparations are used
together maximum total calcipotriol 5 mg in any one
week (e.g. scalp solution 60 mL with ointment 30 g or
scalp solution 30 mL with ointment 60 g); maximum
60 mL per week
l CONTRA-INDICATIONS Calcium metabolism disorders
l CAUTIONS Avoid excessive exposure to sunlight and
sunlamps . avoid use on face . erythrodermic exfoliative
psoriasis (enhanced risk of hypercalcaemia) . generalised
pustular psoriasis (enhanced risk of hypercalcaemia)
l SIDE-EFFECTS
▶ Common or very common Burning . dermatitis . erythema .
itching . local skin reactions . paraesthesia
▶ Rare Facial dermatitis . perioral dermatitis
▶ Frequency not known Aggravation of psoriasis . dry skin .
photosensitivity
l PREGNANCY Manufacturers advise avoid unless essential.
l BREAST FEEDING No information available.
 BNF 70
l PATIENT AND CARER ADVICE Patient information leaflet
for Dovonex ® ointment advises liberal application.
However, patients should be advised of maximum
recommended weekly dose. Hands should be washed
thoroughly after application to avoid inadvertent transfer
to other body areas.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
▶ CALCIPOTRIOL (Non-proprietary)
Calcipotriol (as Calcipotriol hydrate) 50 microgram per 1
ml Calcipotriol 50micrograms/ml scalp solution | 60 ml P £56.55
DT price = £56.55 | 120 ml P £114.45 DT price = £113.09
Ointment
EXCIPIENTS: May contain Disodium edetate, propylene glycol
▶ CALCIPOTRIOL (Non-proprietary)
Calcipotriol 50 microgram per 1 gram Calcipotriol
50micrograms/g ointment | 30 gram P £6.93 DT price = £6.93 |
60 gram P £13.86 | 120 gram P £27.72
▶ Dovonex (LEO Pharma)
Calcipotriol 50 microgram per 1 gram Dovonex 50micrograms/g
ointment | 30 gram P £6.93 DT price = £6.93
Calcipotriol with betamethasone
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, betamethasone p. 993, calcipotriol p. 1036.
INDICATIONS AND DOSE
DOVOBET ® GEL
Scalp psoriasis
TO THE SKIN
▶ Adult: Apply 1–4 g once daily usual duration of
therapy 4 weeks; if necessary, treatment may be
continued beyond 4 weeks or repeated, on the advice
of a specialist, shampoo off after leaving on scalp
overnight or during day, when different preparations
containing calcipotriol used together, maximum total
calcipotriol 5 mg in any one week
Mild to moderate plaque psoriasis
TO THE SKIN
▶ Adult: Apply once daily for 8 weeks; if necessary,
treatment may be continued beyond 8 weeks or
repeated, on the advice of a specialist, apply to
maximum 30% of body surface, when different
preparations containing calcipotriol used together,
max. total calcipotriol 5 mg in any one week;
maximum 15 g per day
DOVOBET ® OINTMENT
Stable plaque psoriasis
TO THE SKIN
▶ Adult: Apply once daily for 4 weeks; if necessary,
treatment may be continued beyond 4 weeks or
repeated, on the advice of a specialist, apply to a
maximum 30% of body surface, when different
preparations containing calcipotriol used together,
max. total calcipotriol 5 mg in any one week;
maximum 15 g per day
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Ointment
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxytoluene
▶ Dovobet (LEO Pharma)
Betamethasone (as Betamethasone dipropionate) 500
microgram per 1 gram, Calcipotriol (as Calcipotriol hydrate) 50
microgram per 1 gram Dovobet ointment | 30 gram P £19.84
DT price = £19.84 | 60 gram P £39.68 | 120 gram P £73.86
Eczema and psoriasis 1037
Gel
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxytoluene
▶ Dovobet (LEO Pharma)
Betamethasone (as Betamethasone dipropionate) 500
microgram per 1 gram, Calcipotriol (as Calcipotriol
monohydrate) 50 microgram per 1 gram Dovobet gel |
60 gram P £33.08 DT price = £33.08 | 120 gram P £61.43
Calcitriol
(1,25-Dihydroxycholecalciferol)
INDICATIONS AND DOSE
Mild to moderate plaque psoriasis
TO THE SKIN
▶ Adult: Apply twice daily, not more than 35% of body
surface to be treated daily; maximum 30 g per day 13
CONTRA-INDICATIONS Do not apply under occlusion .
Skin
l
patients with calcium metabolism disorders
l CAUTIONS Erythrodermic exfoliative psoriasis (enhanced
risk of hypercalcaemia) . generalised pustular psoriasis
(enhanced risk of hypercalcaemia)
l SIDE-EFFECTS
▶ Common or very common Burning . dermatitis . erythema .
itching . local skin reactions . paraesthesia
▶ Frequency not known Aggravation of psoriasis
l PREGNANCY Manufacturer advises use in restricted
amounts only if clearly necessary.
Monitor urine- and serum-calcium concentration in
pregnancy.
l BREAST FEEDING Manufacturer advises avoid.
l HANDLING AND STORAGE Hands should be washed
thoroughly after application to avoid inadvertent transfer
to other body areas.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Ointment
▶ Silkis (Galderma (UK) Ltd)
Calcitriol 3 microgram per 1 gram Silkis ointment |
100 gram P £18.06 DT price = £18.06
Tacalcitol
INDICATIONS AND DOSE
Plaque psoriasis
TO THE SKIN
▶ Adult: Apply once daily, preferably at bedtime,
maximum 10 g ointment or 10 mL lotion daily, when
lotion and ointment used together, maximum total
tacalcitol 280 micrograms in any one week (e.g. lotion
30 mL with ointment 40 g)
l CONTRA-INDICATIONS Calcium metabolism disorders
l CAUTIONS Avoid eyes . erythrodermic exfoliative psoriasis
(enhanced risk of hypercalcaemia) . generalised pustular
psoriasis (enhanced risk of hypercalcaemia) . if used in
conjunction with UV treatment
CAUTIONS, FURTHER INFORMATION
UV treatment If tacalcitol is used in conjunction with UV
treatment, UV radiation should be given in the morning
and tacalcitol applied at bedtime.
l SIDE-EFFECTS
▶ Common or very common Burning . dermatitis . erythema .
itching . local skin reactions . paraesthesia
▶ Frequency not known Aggravation of psoriasis
 1038 Perspiration
l PREGNANCY Manufacturer advises avoid unless no safer
alternative—no information available.
l BREAST FEEDING Manufacturer advises avoid application
to breast area; no information available on presence in
milk.
l MONITORING REQUIREMENTS Monitor serum calcium if
risk of hypercalcaemia.
l PATIENT AND CARER ADVICE Hands should be washed
thoroughly after application to avoid inadvertent transfer
to other body areas.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
EXCIPIENTS: May contain Disodium edetate, propylene glycol
▶ Curatoderm (Almirall Ltd)
13 Tacalcitol (as Tacalcitol monohydrate) 4 microgram per 1
gram Curatoderm 4micrograms/g lotion | 30 ml P £12.73
Skin
Ointment
▶ Curatoderm (Almirall Ltd)
Tacalcitol (as Tacalcitol monohydrate) 4 microgram per 1
gram Curatoderm 4micrograms/g ointment | 30 gram P £13.40
DT price = £13.40 | 60 gram P £23.14 DT price = £23.14 |
100 gram P £30.86 DT price = £30.86
4 Perspiration
Antiperspirants
Aluminium chloride hexahydrate below is a potent
antiperspirant used in the treatment of hyperhidrosis.
Aluminium salts are also incorporated in preparations used
for minor fungal skin infections associated with
hyperhidrosis.
In more severe cases specialists use glycopyrronium
bromide as a 0.05% solution below in the iontophoretic
treatment of hyperhidrosis of plantar and palmar areas.
Botox ® contains botulinum toxin type A complex p. 322
and is licensed for use intradermally for severe
hyperhidrosis of the axillae unresponsive to topical
antiperspirant or other antihidrotic treatment.
4.1 Hyperhidrosis
ALUMINIUM
Aluminium chloride hexahydrate
INDICATIONS AND DOSE
Hyperhidrosis affecting axillae, hands or feet
TO THE SKIN
▶ Adult: Apply once daily, apply liquid formulation at
night to dry skin, wash off the following morning,
reduce frequency as condition improves—do not bathe
immediately before use
Hyperhidrosis | Bromidrosis | Intertrigo | Prevention of tinea
pedis and related conditions
TO THE SKIN
▶ Adult: Apply powder to dry skin
l CAUTIONS Avoid contact with eyes . avoid contact with
mucous membranes . avoid use on broken or irritated skin
. do not shave axillae or use depilatories within 12 hours
of application
l SIDE-EFFECTS Skin irritation
BNF 70
l PATIENT AND CARER ADVICE Avoid contact with clothing.
l EXCEPTIONS TO LEGAL CATEGORY A 30 mL pack of
aluminium chloride hexahydrate 20% is on sale to the
public.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
CAUTIONARY AND ADVISORY LABELS 15
▶ ALUMINIUM CHLORIDE HEXAHYDRATE (Non-proprietary)
Aluminium chloride 200 mg per 1 ml Aluminium chloride 20%
solution | 60 ml p no price available
▶ Anhydrol (Dermal Laboratories Ltd)
Aluminium chloride 200 mg per 1 ml Anhydrol Forte 20%
solution | 60 ml p £2.51
▶ Driclor (GlaxoSmithKline Consumer Healthcare)
Aluminium chloride 200 mg per 1 ml Driclor 20% solution |
20 ml G £3.51 | 75 ml p £3.01
Spray
▶ ALUMINIUM CHLORIDE HEXAHYDRATE (Non-proprietary)
Aluminium chloride 200 mg per 1 ml Aluminium chloride 20%
spray | 30 ml no price available
▶ Odaban (Bracey’s Pharmaceuticals Ltd)
Aluminium chloride 200 mg per 1 ml Odaban 20% spray | 30 ml
£6.69
ANTIMUSCARINICS
Glycopyrronium bromide
(Glycopyrrolate)
INDICATIONS AND DOSE
Iontophoretic treatment of hyperhidrosis
TO THE SKIN
▶ Adult: Only 1 site to be treated at a time, maximum
2 sites treated in any 24 hours, treatment not to be
repeated within 7 days (consult product literature)
l CONTRA-INDICATIONS Infections affecting the treatment
site
CONTRA-INDICATIONS, FURTHER INFORMATION
Contra-indications applicable to systemic use should be
considered; however, glycopyrronium is poorly absorbed
and systemic effects unlikely with topical use.
l CAUTIONS
Cautions applicable to systemic use should be considered;
however, glycopyrronium is poorly absorbed and systemic
l
effects unlikely with topical use.
SIDE-EFFECTS Tingling at administration site
SIDE-EFFECTS, FURTHER INFORMATION
The possibility of systemic side-effects should be
considered; however, glycopyrrhonium is poorly absorbed
and systemic effects unlikely with topical use.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: cream, liquid
Powder for solution for iontophoresis
▶ Robinul (AMCo)
Glycopyrronium bromide 1 mg per 1 mg Robinul powder for
solution for iontophoresis | 3 gram P £266.00
 BNF 70
5 Photodamage
Photodamage
Photodamage
Patients should be advised to use a high-SPF sunscreen and
to minimise exposure of the skin to direct sunlight or sun
lamps.
Topical treatments can be used for actinic keratosis. An
emollient may be sufficient for mild lesions. Diclofenac
sodium p. 921 is suitable for the treatment of superficial
lesions in mild disease. Fluorouracil cream p. 761 is
effective against most types of non-hypertrophic actinic
keratosis; a solution containing fluorouracil and salicylic
acid is available for the treatment of low or moderately thick
hyperkeratotic actinic keratosis. Imiquimod p. 1057 is used
for lesions on the face and scalp when cryotherapy or other
topical treatments cannot be used. Fluorouracil and
imiquimod produce a more marked inflammatory reaction
than diclofenac but lesions resolve faster. A short course of
ingenol mebutate below is licensed for the treatment of
non-hypertrophic actinic keratosis; response to treatment
can usually be assessed 8 weeks after the course.
Photodynamic therapy in combination with methyl-
5-aminolevulinate cream (Metvix, available from Galderma)
or 5-aminolaevulinic acid gel (Ameluz, available from Spirit
Healthcare) is used in specialist centres for treating
superficial and confluent, non-hypertrophic actinic
keratosis when other treatments are inadequate or
unsuitable; it is particularly suitable for multiple lesions, for
periorbital lesions, or for lesions located at sites of poor
healing.
Imiquimod or topical fluorouracil is used for treating
superficial basal cell carcinomas. Photodynamic therapy in
combination with methyl-5-aminolevulinate cream is used
in specialist centres for treating superficial, nodular basal
cell carcinomas when other treatments are unsuitable.
ANTIMETABOLITES
Fluorouracil
INDICATIONS AND DOSE
Superficial malignant and pre-malignant skin lesions
TO THE SKIN USING CREAM
Adult: Apply 1–2 times a day for 3–4 weeks (usual
▶
duration of initial therapy), apply thinly to the
affected area, maximum area of skin 500 cm2 (e.g.
23 cm 6 23 cm) treated at one time, alternative
regimens may be used in some settings
l CAUTIONS Avoid contact with eyes and mucous
membranes . do not apply to bleeding lesions
l SIDE-EFFECTS Erythema multiforme . local irritation (use
a topical corticosteroid for severe discomfort associated
with inflammatory reactions) . photosensitivity
l PREGNANCY Manufacturers advise avoid (teratogenic).
l BREAST FEEDING Manufacturers advise avoid.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens), polysorbates, propylene
glycol
▶ Efudix (Meda Pharmaceuticals Ltd)
Fluorouracil 50 mg per 1 gram Efudix 5% cream | 40 gram P
£32.90 DT price = £32.90
Photodamage 1039
Fluorouracil with salicylic acid
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, fluorouracil p. 761, salicylic acid p. 1057.
INDICATIONS AND DOSE
Low or moderately thick hyperkeratotic actinic keratosis
TO THE SKIN
▶ Adult: Apply once daily for up to 12 weeks, reduced to
3 times a week if severe side effects occur and until
side-effects improve, to be applied to the affected
area, if treating area with thin epidermis, reduce
frequency of application and monitor response more
often; maximum area of skin treated at one time,
25 cm2 (e.g. 5 cm x 5 cm)
l MEDICINAL FORMS 13
There can be variation in the licensing of different medicines
containing the same drug.
Skin
Cutaneous solution
CAUTIONARY AND ADVISORY LABELS 15
▶ Actikerall (Almirall Ltd)
Fluorouracil 5 mg/g, Salicylic acid 100 mg/g Actikerall 5mg/g /
100mg/g cutaneous solution | 25 ml P £38.30
PROTEIN KINASE C ACTIVATORS
Ingenol mebutate
INDICATIONS AND DOSE
Actinic keratosis on face and scalp
TO THE SKIN
▶ Adult: Apply once daily for 3 days, use the
150 microgram/g gel
Actinic keratosis on trunk and extremities
TO THE SKIN
▶ Adult: Apply once daily for 2 days, use the
500 microgram/g gel
l CAUTIONS Avoid contact with broken skin . avoid contact
with eyes . avoid contact with inside of ears . avoid
contact with inside of nostrils . avoid contact with lips .
avoid occlusive dressings on treated area
l SIDE-EFFECTS
▶ Common or very common Blistering . crusting . erosion .
erythema . exfoliation . headache . infection . local
reactions . oedema . pain . pruritus
▶ Uncommon Local ulceration . paraesthesia
l PREGNANCY Not absorbed from skin, but manufacturer
advises avoid.
l BREAST FEEDING Not absorbed from skin; ensure infant
does not come in contact with treated area for 6 hours
after application.
l DIRECTIONS FOR ADMINISTRATION One tube covers skin
area of 25 cm2. Allow gel to dry on treatment area for 15
minutes. Avoid washing or touching the treated area for 6
hours after application; after this time, area may be
washed with mild soap and water. Avoid use immediately
after shower or less than 2 hours before bedtime.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Gel
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Benzyl alcohol
▶ Picato (LEO Pharma) A
Ingenol mebutate 150 microgram per 1 gram Picato
150micrograms/g gel | 1.41 gram P £65.00
Ingenol mebutate 500 microgram per 1 gram Picato
500micrograms/g gel | .94 gram P £65.00
 1040 Pruritis
6 Pruritis
Topical local antipruritics
Pruritus may be caused by systemic disease (such as
obstructive jaundice, endocrine disease, chronic renal
disease, iron deficiency, and certain malignant diseases),
skin disease (e.g. psoriasis, eczema, urticaria, and scabies),
drug hypersensitivity, or as a side-effect of opioid
analgesics. Where possible, the underlying causes should be
treated. An emollient may be of value where the pruritus is
associated with dry skin. Pruritus that occurs in otherwise
healthy elderly people can also be treated with an emollient.
Levomenthol cream below can be used to relieve pruritus; it
exerts a cooling effect on the skin. Local antipruritics have a
13 role in the treatment of pruritus in palliative care.
Preparations containing crotamiton below are sometimes
Skin
used but are of uncertain value. Preparations containing
calamine are often ineffective.
A topical preparation containing doxepin 5% below is
licensed for the relief of pruritus in eczema; it can cause
drowsiness and there may be a risk of sensitisation.
Pruritus is common in biliary obstruction, especially in
primary biliary cirrhosis and drug-induced cholestasis. Oral
administration of colestyramine p. 173 is the treatment of
choice.
Topical antihistamines and local anaesthetics are only
marginally effective and occasionally cause hypersensitivity.
For insect stings and insect bites, a short course of a topical
corticosteroid is appropriate. Short-term treatment with a
sedating antihistamine may help in insect stings and in
intractable pruritus where sedation is desirable. Calamine
preparations are of little value for the treatment of insect
stings or bites and are no longer widely available.
Topical local anaesthetics are indicated for the relief of
local pain. Preparations may be absorbed, especially
through mucosal surfaces, therefore excessive application
should be avoided and they should preferably not be used
for more than 3 days; not generally suitable for young
children and are less suitable for prescribing.
Topical antihistamines should be avoided in eczema and
are not recommended for longer than 3 days. They are less
suitable for prescribing.
ANTIPRURITICS
Crotamiton
INDICATIONS AND DOSE
Pruritus (including pruritus after scabies)
TO THE SKIN
▶ Child 1 month–2 years (on doctor’s advice only): Apply once
daily
▶ Child 3–17 years: Apply 2–3 times a day
Adult: Apply 2–3 times a day
▶
l CONTRA-INDICATIONS Acute exudative dermatoses
l CAUTIONS Avoid use in buccal mucosa . avoid use near
eyes . avoid use on broken skin . avoid use on very
inflamed skin . use on doctor’s advice for children under 3
years
l PREGNANCY Manufacturer advises avoid, especially
during the first trimester—no information available.
l BREAST FEEDING No information available; avoid
application to nipple area.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
BNF 70
Liquid
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), fragrances, propylene glycol, sorbic acid
▶ Eurax (Novartis Consumer Health UK Ltd)
Crotamiton 100 mg per 1 ml Eurax lotion | 100 ml G £3.14 DT
price = £3.14
Cream
EXCIPIENTS: May contain Beeswax, cetostearyl alcohol (including cetyl
and stearyl alcohol), fragrances, hydroxybenzoates (parabens)
▶ Eurax (Novartis Consumer Health UK Ltd)
Crotamiton 100 mg per 1 gram Eurax 10% cream | 30 gram G
£2.38 DT price = £2.38 | 100 gram G £4.15 DT price = £4.15
Doxepin
INDICATIONS AND DOSE
Pruritus in eczema
TO THE SKIN
▶ Child 12–17 years: Apply up to 3 g 3–4 times a day, apply
thinly; coverage should be less than 10% of body
surface area; maximum 12 g per day
▶ Adult: Apply up to 3 g 3–4 times a day, apply thinly;
coverage should be less than 10% of body surface area;
maximum 12 g per day
l CAUTIONS Avoid application to large areas . cardiac
arrthymias . mania . severe heart disease . susceptibility to
angle-closure glaucoma . urinary retention
l SIDE-EFFECTS
▶ Common or very common Dizziness . drowsiness
▶ Frequency not known Antimuscarinic effects . fever .
gastro-intestinal disturbances . headache . irritation . local
burning . rash . stinging . tingling
l PREGNANCY Manufacturer advises use only if potential
benefit outweighs risk.
l BREAST FEEDING Manufacturer advises use only if
potential benefit outweighs risk.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
severe liver disease.
l PATIENT AND CARER ADVICE Drowsiness may affect
performance of skilled tasks (e.g. driving). Effects of
alcohol enhanced. A patient information leaflet should be
provided.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 2, 10
EXCIPIENTS: May contain Benzyl alcohol
▶ Xepin (Cambridge Healthcare Supplies Ltd)
Doxepin hydrochloride 50 mg per 1 gram Xepin 5% cream |
30 gram P £11.70
MENTHOL AND DERIVATIVES
Levomenthol
INDICATIONS AND DOSE
Pruritus
TO THE SKIN
▶ Adult: Apply 1–2 times a day
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Levomenthol
cream, BP (Menthol in Aqueous Cream) consists of
levomenthol 0.5%.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: cream
 BNF 70
Cream
▶ Dermacool (Pern Consumer Products Ltd)
Menthol 5 mg per 1 gram Dermacool 0.5% cream | 100 gram
£3.85 | 500 gram £16.07 DT price = £16.07
Menthol 10 mg per 1 gram Dermacool 1% cream | 20 gram
£1.49 | 100 gram £3.97 DT price = £3.97 | 500 gram £16.59 DT price
= £16.59
Menthol 20 mg per 1 gram Dermacool 2% cream | 100 gram
£4.07 | 500 gram £16.97 DT price = £16.97
Menthol 50 mg per 1 gram Dermacool 5% cream | 20 gram
£1.58 | 100 gram £4.69 | 500 gram £17.48
▶ Brands may include Aqua-cool cream, AquaSoothe cream, Arjun
cream
7 Rosacea and acne
Rosacea and acne
Acne
Treatment of acne should be commenced early to prevent
scarring. Patients should be counselled that an
improvement may not be seen for at least a couple of
months. The choice of treatment depends on whether the
acne is predominantly inflammatory or comedonal and its
severity.
Mild to moderate acne is generally treated with topical
preparations. Systemic treatment with oral antibacterials is
generally used for moderate to severe acne or where topical
preparations are not tolerated or are ineffective or where
application to the site is difficult. Another oral preparation
used for acne is the hormone treatment co-cyprindiol
(cyproterone acetate with ethinylestradiol p. 1042); it is for
women only.
Severe acne, acne unresponsive to prolonged courses of
oral antibacterials, scarring, or acne associated with
psychological problems calls for early referral to a
consultant dermatologist who may prescribe isotretinoin
p. 1045 for administration by mouth.
Topical preparations for acne
In mild to moderate acne, comedones and inflamed lesions
respond well to benzoyl peroxide p. 1044 or to a topical
retinoid. Alternatively, topical application of an
antibacterial such as erythromycin p. 1043 or clindamycin
p. 467 may be effective for inflammatory acne. If topical
preparations prove inadequate, oral preparations may be
needed.
Benzoyl peroxide and azelaic acid
Benzoyl peroxide p. 1044 is effective in mild to moderate
acne. Both comedones and inflamed lesions respond well to
benzoyl peroxide. The lower concentrations seem to be as
effective as higher concentrations in reducing
inflammation. It is usual to start with a lower strength and
to increase the concentration of benzoyl peroxide gradually.
Adverse effects include local skin irritation, particularly
when therapy is initiated, but the scaling and redness often
subside with treatment continued at a reduced frequency of
application. If the acne does not respond after 2 months
then use of a topical antibacterial should be considered.
Azelaic acid p. 1043 has antimicrobial and anticomedonal
properties. It may be an alternative to benzoyl peroxide or
to a topical retinoid for treating mild to moderate
comedonal acne, particularly of the face. Some patients
prefer azelaic acid because it is less likely to cause local
irritation than benzoyl peroxide.
Topical antibacterials for acne
For many patients with mild to moderate inflammatory
acne, topical antibacterials may be no more effective than
topical benzoyl peroxide or tretinoin. Topical antibacterials
Rosacea and acne 1041
are probably best reserved for patients who wish to avoid
oral antibacterials or who cannot tolerate them. Topical
preparations of erythromycin p. 1043 and clindamycin
p. 467 are effective for inflammatory acne. Topical
antibacterials can produce mild irritation of the skin, and on
rare occasions cause sensitisation; gastro-intestinal
disturbances have been reported with topical clindamycin.
Antibacterial resistance of Propionibacterium acnes is
increasing; there is cross-resistance between erythromycin
and clindamycin. To avoid development of resistance:
. when possible use non-antibiotic antimicrobials (such
as benzoyl peroxide or azelaic acid);
. avoid concomitant treatment with different oral and
topical antibacterials;
. if a particular antibacterial is effective, use it for repeat
courses if needed (short intervening courses of benzoyl
peroxide or azelaic acid may eliminate any resistant
propionibacteria); 13
. do not continue treatment for longer than necessary
Skin
(however, treatment with a topical preparation should
be continued for at least 6 months).
Some manufacturers of topical antibacterial preparations
for acne advise that preparations containing alcohol are not
suitable for use with benzoyl peroxide.
Topical retinoids and related preparations for acne
Topical tretinoin p. 769, its isomer isotretinoin p. 1045, and
adapalene p. 1045 (a retinoid-like drug), are useful for
treating comedones and inflammatory lesions in mild to
moderate acne. Several months of treatment may be needed
to achieve an optimal response and the treatment should be
continued until no new lesions develop. Isotretinoin is
given by mouth in severe acne.
Other topical preparations for acne
Preparations containing aluminium oxide p. 1042 are not
considered beneficial in acne.
A topical preparation of nicotinamide p. 1048 is available
for inflammatory acne.
Oral preparations for acne
Systemic antibacterial treatment is useful for inflammatory
acne if topical treatment is not adequately effective or if it is
inappropriate. Anticomedonal treatment (e.g. with topical
benzoyl peroxide p. 1044) may also be required.
Either oxytetracycline p. 498 or tetracycline p. 498 is
usually given for acne. If there is no improvement after the
first 3 months another oral antibacterial should be used.
Maximum improvement usually occurs after 4 to 6 months
but in more severe cases treatment may need to be
continued for 2 years or longer.
Doxycycline p. 995 and lymecycline p. 497 are alternatives
to tetracycline.
Although minocycline p. 498 is as effective as other
tetracyclines for acne, it is associated with a greater risk of
lupus erythematosus-like syndrome. Minocycline
sometimes causes irreversible pigmentation; it is given in a
once or twice daily dose.
Erythromycin p. 1043 in a twice daily dose is an
alternative for the management of acne but propionibacteria
strains resistant to erythromycin are becoming widespread
and this may explain poor response.
Trimethoprim p. 462 may be used for acne resistant to
other antibacterials [unlicensed indication]. Prolonged
treatment with trimethoprim may depress haematopoiesis;
it should generally be initiated by specialists.
Concomitant use of different topical and systemic
antibacterials is undesirable owing to the increased
likelihood of the development of bacterial resistance.
Hormone treatment for acne
Co-cyprindiol (cyproterone acetate with ethinylestradiol
p. 1042) contains an anti-androgen. It is licensed for use in
women with moderate to severe acne that has not
 1042 Rosacea and acne
responded to topical therapy or oral antibacterials, and for
moderately severe hirsutism. Although it is an effective
hormonal contraceptive, it should not be used solely for
contraception.
Improvement of acne with co-cyprindiol probably occurs
because of decreased sebum secretion which is under
androgen control. Some women with moderately severe
hirsutism may also benefit because hair growth is also
androgen-dependent.
Oral retinoid for acne
The retinoid isotretinoin p. 1045 reduces sebum secretion.
It is used for the systemic treatment of nodulo-cystic and
conglobate acne, severe acne, scarring, acne which has not
responded to an adequate course of a systemic antibacterial,
or acne which is associated with psychological problems. It
is also useful in women who develop acne in the third or
13 fourth decades of life, since late onset acne is frequently
unresponsive to antibacterials.
Isotretinoin is a toxic drug that should be prescribed only
Skin
by, or under the supervision of, a consultant dermatologist.
It is given for at least 16 weeks; repeat courses are not
normally required.
Side-effects of isotretinoin include severe dryness of the
skin and mucous membranes, nose bleeds, and joint pains.
The drug is teratogenic and must not be given to women of
child-bearing age unless they practise effective
contraception (oral progestogen-only contraceptives not
considered effective) and then only after detailed
assessment and explanation by the physician. Women must
also be registered with a pregnancy prevention programme.
Although a causal link between isotretinoin use and
psychiatric changes (including suicidal ideation) has not
been established, the possibility should be considered
before initiating treatment; if psychiatric changes occur
during treatment, isotretinoin should be stopped, the
prescriber informed, and specialist psychiatric advice should
be sought.
Rosacea
Rosacea is not comedonal (but may exist with acne which
may be comedonal). Brimonidine tartrate p. 1048 is licensed
for the treatment of facial erythema in rosacea. The
pustules and papules of rosacea respond to topical
metronidazole p. 1008 or to topical azelaic acid p. 1043.
Alternatively oral administration of oxytetracycline p. 498
or tetracycline p. 498, or erythromycin p. 1043, can be used;
courses usually last 6–12 weeks and are repeated
intermittently. Doxycycline p. 995 can be used [unlicensed
indication] if oxytetracycline or tetracycline is inappropriate
(e.g. in renal impairment). A modified-release preparation
of doxycycline is licensed in low daily doses for the
treatment of facial rosacea. Isotretinoin p. 1045 is
occasionally given in refractory cases [unlicensed
indication]. Camouflagers may be required for the redness.
7.1 Acne
ABRASIVE AGENTS
Aluminium oxide
INDICATIONS AND DOSE
Acne vulgaris
TO THE SKIN
▶ Adult: Apply 1–3 times a day, to be used instead of
soap
l CONTRA-INDICATIONS Superficial venules . telangiectasia
l CAUTIONS Avoid contact with eyes
BNF 70
l SIDE-EFFECTS Skin irritation (discontinue use
temporarily)
l TREATMENT CESSATION Discontinue use temporarily if
skin becomes irritated.
l LESS SUITABLE FOR PRESCRIBING Less suitable for
prescribing (not considered beneficial).
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Paste
EXCIPIENTS: May contain Fragrances, n-(3-chloroallyl)hexaminium
chloride (quaternium 15)
▶ Brasivol (GlaxoSmithKline Consumer Healthcare)
Aluminium oxide 380 mg per 1 gram Brasivol Fine No.1 38%
paste | 75 gram G £2.76
ANTI-ANDROGENS
Co-cyprindiol
INDICATIONS AND DOSE
Moderate to severe acne in women of child-bearing age
refractory to topical therapy or oral antibacterials |
Moderately severe hirsutism
BY MOUTH
▶ Females of childbearing potential: 1 tablet daily for
21 days, to be started on day 1 of menstrual cycle;
subsequent courses repeated after a 7-day interval
(during which withdrawal bleeding occurs), time to
symptom remission, at least 3 months; review need for
treatment regularly
l CONTRA-INDICATIONS Acute porphyria . gallstones . heart
disease associated with pulmonary hypertension or risk of
embolus . history during pregnancy of cholestatic jaundice
. history during pregnancy of chorea . history during
pregnancy of pemphigoid gestationis . history during
pregnancy of pruritus . history of breast cancer but can be
used after 5 years if no evidence of disease and non-
hormonal methods unacceptable . history of haemolytic
uraemic syndrome . migraine with aura . personal history
of venous or arterial thrombosis . sclerosing treatment for
varicose veins . severe or multiple risk factors for arterial
disease or for venous thromboembolism . systemic lupus
erythematosus with (or unknown) antiphospholipid
antibodies . transient cerebral ischaemic attacks without
headaches . undiagnosed vaginal bleeding
l CAUTIONS Active trophoblastic disease (until return to
normal of urine- and plasma-gonadotrophin
concentration)—seek specialist advice . arterial disease .
gene mutations associated with breast cancer (e.g. BRCA
1) . history of severe depression especially if induced by
hormonal contraceptive . hyperprolactinaemia—seek
specialist advice . inflammatory bowel disease including
Crohn’s disease . migraine . personal or family history of
hypertriglyceridaemia (increased risk of pancreatitis) . risk
factors for venous thromboembolism . sickle-cell disease .
undiagnosed breast mass
CAUTIONS, FURTHER INFORMATION
Venous thromboembolism There is an increased risk of
venous thromboembolism in women taking co-cyprindiol,
particularly during the first year of use. The incidence of
venous thromboembolism is 1.5–2 times higher in women
using co-cyprindiol than in women using combined oral
contraceptives containing levonorgestrel, but the risk may
be similar to that associated with use of combined oral
contraceptives containing third generation progestogens
(desogestrel and gestodene) or drospirenone. Women
requiring co-cyprindiol may have an inherently increased
risk of cardiovascular disease.
l INTERACTIONS → Appendix 1 (oestrogens).
 BNF 70 Acne 1043

l SIDE-EFFECTS l SIDE-EFFECTS
▶ Rare Rarely gallstones . systemic lupus erythematosus ▶ Common or very common Local irritation (reduce
▶ Very rare Photosensitivity frequency or discontinue temporarily)
▶ Frequency not known Abdominal cramps . absence of ▶ Uncommon Skin discoloration
withdrawal bleeding . amenorrhoea after discontinuation . ▶ Frequency not known Worsening of asthma
breast enlargement . breast secretion . breast tenderness .
cervical erosion . changes in libido . changes in lipid l MEDICINAL FORMS
metabolism . changes in vaginal discharge . chloasma . There can be variation in the licensing of different medicines
containing the same drug.
chorea . contact lenses may irritate . depression . fluid
Cream
retention . headache . hepatic tumours . hypertension . EXCIPIENTS: May contain Propylene glycol
irritability . leg cramps . liver impairment . nausea . Skinoren (Bayer Plc)
nervousness . reduced menstrual loss . skin reactions .
▶
Azelaic acid 200 mg per 1 gram Skinoren 20% cream |
thrombosis (more common when factor V Leiden present 30 gram P £3.74 DT price = £3.74
or in blood groups A, B, and AB . visual disturbances . Gel
vomiting . ‘spotting’ in early cycles EXCIPIENTS: May contain Disodium edetate, polysorbates, propylene
l PREGNANCY Avoid—risk of feminisation of male fetus glycol
▶ Finacea (Bayer Plc)
with cyproterone.
l BREAST FEEDING Manufacturer advises avoid; possibility
Azelaic acid 150 mg per 1 gram Finacea 15% gel | 30 gram P 13
£7.48 DT price = £7.48
of anti-androgen effects in neonate with cyproterone.

Skin
l HEPATIC IMPAIRMENT Avoid in active liver disease ANTI-INFECTIVES
including disorders of hepatic excretion (e.g. Dubin-
Johnson or Rotor syndromes), infective hepatitis (until
liver function returns to normal), and liver tumours.
Erythromycin F
The properties listed below are those particular to the drug
l PRESCRIBING AND DISPENSING INFORMATION A mixture only. For properties common to the class, see macrolides,
of cyproterone acetate and ethinylestradiol in the mass p. 469.
proportions 2000 parts to 35 parts, respectively.
INDICATIONS AND DOSE
l MEDICINAL FORMS Rosacea
There can be variation in the licensing of different medicines
containing the same drug. BY MOUTH
Tablet
▶ Adult: 500 mg twice daily courses usually last
▶ CO-CYPRINDIOL (Non-proprietary) 6–12 weeks and are repeated intermittently
Cyproterone acetate 2 mg, Ethinylestradiol 35 microgram Co- Acne
cyprindiol 2000microgram/35microgram tablets | 63 tablet P BY MOUTH
£5.65 DT price = £5.42 ▶ Adult: 500 mg twice daily
▶ Dianette (Mylan Ltd, Bayer Plc) A
STIEMYCIN ®
Cyproterone acetate 2 mg, Ethinylestradiol 35
microgram Dianette tablets | 63 tablet P £7.71–£11.10 DT price Acne vulgaris
= £5.42 TO THE SKIN
▶ Brands may include Clairette tablets ▶ Child 12–17 years: Apply twice daily, to be applied thinly
▶ Adult: Apply twice daily, to be applied thinly
ANTICOMEDONALS
l CAUTIONS
Azelaic acid ▶ With systemic use avoid in acute porphyrias p. 864
STIEMYCIN ®
INDICATIONS AND DOSE Some manufacturers advise preparations containing
FINACEA ® alcohol are not suitable for use with benzoyl peroxide
Facial acne vulgaris l INTERACTIONS → Appendix 1 (macrolides).
TO THE SKIN Caution with concomitant use of drugs that prolong the
▶ Child 12–17 years: Apply twice daily, discontinue if no QT interval.
improvement after 1 month ▶ With topical use Interactions do not apply to small amounts
▶ Adult: Apply twice daily, discontinue if no of erythromycin used topically.
improvement after 1 month l PREGNANCY
Papulopustular rosacea ▶ With systemic use Not known to be harmful.
TO THE SKIN l BREAST FEEDING
▶ Adult: Apply twice daily, discontinue if no ▶ With systemic use Only small amounts in milk—not known
improvement after 2 months to be harmful.
SKINOREN ® l HEPATIC IMPAIRMENT
Acne vulgaris ▶ With systemic use May cause idiosyncratic hepatotoxicity.
TO THE SKIN l RENAL IMPAIRMENT
▶ Child 12–17 years: Apply twice daily ▶ With systemic use in adults Max. 1.5 g daily in severe renal
▶ Adult: Apply twice daily impairment (ototoxicity).
Acne vulgaris in patients with sensitive skin ▶ With systemic use in children Reduce dose in severe renal
TO THE SKIN impairment (ototoxicity).
▶ Child 12–17 years: Apply once daily for 1 week, then l PRESCRIBING AND DISPENSING INFORMATION
apply twice daily ▶ With oral use Flavours of oral liquid formulations may
▶ Adult: Apply once daily for 1 week, then apply twice include banana
daily
l MEDICINAL FORMS
l CAUTIONS Avoid contact with eyes . avoid contact with There can be variation in the licensing of different medicines
mouth . avoid contact with mucous membranes containing the same drug. Forms available from special-order
manufacturers include: gel, ointment
 1044 Rosacea and acne
Tablet
CAUTIONARY AND ADVISORY LABELS 9
▶ Erythrocin (AMCo)
Erythromycin (as Erythromycin stearate) 250 mg Erythrocin 250
tablets | 100 tablet P £18.20 DT price = £18.20
Erythromycin (as Erythromycin stearate) 500 mg Erythrocin 500
tablets | 100 tablet P £36.40 DT price = £36.40
▶ Erythroped A (AMCo)
Erythromycin (as Erythromycin ethyl succinate)
500 mg Erythroped A 500mg tablets | 28 tablet P £10.78 DT
price = £10.78
Gastro-resistant tablet
CAUTIONARY AND ADVISORY LABELS 5, 9, 25
▶ ERYTHROMYCIN (Non-proprietary)
Erythromycin 250 mg Erythromycin 250mg gastro-resistant
tablets | 28 tablet P £3.00 DT price = £1.88 | 500 tablet P
£33.57
Gastro-resistant capsule
13 CAUTIONARY AND ADVISORY LABELS 5, 9, 25
▶ ERYTHROMYCIN (Non-proprietary)
Erythromycin 250 mg Erythromycin 250mg gastro-resistant
Skin
capsules | 28 capsule P £23.53 DT price = £5.61 |
30 capsule P no price available
▶ Brands may include Erymax, Tiloryth
Oral suspension
CAUTIONARY AND ADVISORY LABELS 9
▶ ERYTHROMYCIN (Non-proprietary)
Erythromycin (as Erythromycin ethyl succinate) 25 mg per 1
ml Erythromycin ethyl succinate 125mg/5ml oral suspension |
100 ml P £3.53 DT price = £3.53
Erythromycin ethyl succinate 125mg/5ml oral suspension sugar free
(sugar-free) | 100 ml P £4.00 DT price = £3.28
Erythromycin (as Erythromycin ethyl succinate) 50 mg per 1
ml Erythromycin ethyl succinate 250mg/5ml oral suspension |
100 ml P £5.54 DT price = £5.53
Erythromycin ethyl succinate 250mg/5ml oral suspension sugar free
(sugar-free) | 100 ml P £7.99 DT price = £4.48
Erythromycin (as Erythromycin ethyl succinate) 100 mg per 1
ml Erythromycin ethyl succinate 500mg/5ml oral suspension |
100 ml P £10.43 DT price = £10.43
Erythromycin ethyl succinate 500mg/5ml oral suspension sugar free
(sugar-free) | 100 ml P £12.99 DT price = £12.99
▶ Erythroped (AMCo)
Erythromycin (as Erythromycin ethyl succinate) 25 mg per 1
ml Erythroped PI SF 125mg/5ml oral suspension (sugar-free) |
140 ml P £3.06
Erythromycin (as Erythromycin ethyl succinate) 50 mg per 1
ml Erythroped SF 250mg/5ml oral suspension (sugar-free) |
140 ml P £5.95
Erythromycin (as Erythromycin ethyl succinate) 100 mg per 1
ml Erythroped Forte SF 500mg/5ml oral suspension (sugar-free) |
140 ml P £10.56
Liquid
EXCIPIENTS: May contain Propylene glycol
▶ Stiemycin (Stiefel Laboratories (UK) Ltd)
Erythromycin 20 mg per 1 ml Stiemycin 2% solution | 50 ml P 150 ml p £4.00 DT price = £4.00
£7.69 DT price = £7.69
Erythromycin with zinc acetate
INDICATIONS AND DOSE
Acne vulgaris
TO THE SKIN
▶ Child: Apply twice daily
▶ Adult: Apply twice daily
l CAUTIONS Some manufacturers advise preparations
containing alcohol are not suitable for use with benzoyl
peroxide
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
BNF 70
Liquid
▶ Zineryt (Astellas Pharma Ltd)
Erythromycin 40 mg per 1 ml, Zinc acetate 12 mg per 1
ml Zineryt lotion | 30 ml P £7.71 DT price = £7.71 | 90 ml P
£16.68 DT price = £16.68
PEROXIDES
Benzoyl peroxide
INDICATIONS AND DOSE
Acne vulgaris
TO THE SKIN
▶ Child 12–17 years: Apply 1–2 times a day, preferably
apply after washing with soap and water, start
treatment with lower-strength preparations
▶ Adult: Apply 1–2 times a day, preferably apply after
washing with soap and water, start treatment with
lower-strength preparations
l CAUTIONS Avoid contact with broken skin . avoid contact
with eyes . avoid contact with mouth . avoid contact with
mucous membranes . avoid excessive exposure to sunlight
l SIDE-EFFECTS Skin irritation
SIDE-EFFECTS, FURTHER INFORMATION
Skin irritation Reduce frequency or suspend use until
irritation subsides and re-introduce at reduced frequency.
l PATIENT AND CARER ADVICE May bleach fabrics and hair.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), fragrances, isopropyl palmitate, propylene glycol
▶ Brevoxyl (GlaxoSmithKline Consumer Healthcare)
Benzoyl peroxide 40 mg per 1 gram Brevoxyl 4% cream |
50 gram p £4.13 DT price = £4.13
▶ PanOxyl (GlaxoSmithKline Consumer Healthcare)
Benzoyl peroxide 50 mg per 1 gram PanOxyl 5 cream |
40 gram p £1.89 DT price = £1.89
Gel
EXCIPIENTS: May contain Fragrances, propylene glycol
▶ Acnecide (Galderma (UK) Ltd)
Benzoyl peroxide 50 mg per 1 gram Acnecide 5% gel |
30 gram p £5.44 DT price = £5.44 | 60 gram p £12.56
Acnecide Wash 5% gel | 50 gram p £5.44
▶ Brands may include PanOxyl Acnegel, PanOxyl Aquagel
Wash
EXCIPIENTS: May contain Imidurea
▶ PanOxyl (GlaxoSmithKline Consumer Healthcare)
Benzoyl peroxide 100 mg per 1 gram PanOxyl 10 wash |
Benzoyl peroxide with clindamycin
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, benzoyl peroxide above, clindamycin p. 467.
INDICATIONS AND DOSE
Acne vulgaris
TO THE SKIN
▶ Child 12–17 years: Apply once daily, dose to be applied
in the evening
▶ Adult: Apply once daily, dose to be applied in the
evening
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
 BNF 70
Gel
EXCIPIENTS: May contain Disodium edetate
▶ Duac (Stiefel Laboratories (UK) Ltd)
Benzoyl peroxide 30 mg per 1 gram, Clindamycin (as
Clindamycin phosphate) 10 mg per 1 gram Duac Once Daily gel
(3% and 1%) | 30 gram P £13.14 DT price = £13.14
Benzoyl peroxide 50 mg per 1 gram, Clindamycin (as
Clindamycin phosphate) 10 mg per 1 gram Duac Once Daily gel
(5% and 1%) | 25 gram P £10.95 DT price = £10.95 |
50 gram P £21.89 DT price = £21.89
RETINOID AND RELATED DRUGS
Adapalene
INDICATIONS AND DOSE
Mild to moderate acne vulgaris
TO THE SKIN
▶ Child 12–17 years: Apply once daily, apply thinly in the
evening
▶ Adult: Apply once daily, apply thinly in the evening
l CAUTIONS Avoid accumulation in angles of the nose .
avoid contact with eyes, nostrils, mouth and mucous
membranes, eczematous, broken or sunburned skin .
avoid exposure to UV light (including sunlight, solariums) .
avoid in severe acne involving large areas . caution in
sensitive areas such as the neck
l PREGNANCY Avoid.
l BREAST FEEDING Amount of drug in milk probably too
small to be harmful; ensure infant does not come in
contact with treated areas.
l PATIENT AND CARER ADVICE If sun exposure is
unavoidable, an appropriate sunscreen or protective
clothing should be used.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Disodium edetate, hydroxybenzoates
(parabens)
▶ ADAPALENE (Non-proprietary)
Adapalene 1 mg per 1 gram Adapalene 0.1% cream |
45 gram P £16.43 DT price = £16.43
▶ Differin (Galderma (UK) Ltd)
Adapalene 1 mg per 1 gram Differin 0.1% cream | 45 gram P
£16.43 DT price = £16.43
Gel
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Disodium edetate, hydroxybenzoates
(parabens), propylene glycol
▶ ADAPALENE (Non-proprietary)
Adapalene 1 mg per 1 gram Adapalene 0.1% gel | 45 gram P
£16.43 DT price = £16.43
▶ Differin (Galderma (UK) Ltd)
Adapalene 1 mg per 1 gram Differin 0.1% gel | 45 gram P
£16.43 DT price = £16.43
Adapalene with benzoyl peroxide
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, adapalene above, benzoyl peroxide p. 1044.
INDICATIONS AND DOSE
Acne vulgaris
TO THE SKIN
Child 9–17 years: Apply once daily, to be applied thinly
▶
in the evening
Adult: Apply once daily, to be applied thinly in the
▶
evening
Acne 1045
l PATIENT AND CARER ADVICE Gel may bleach clothing and
hair.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
The Scottish Medicines Consortium has advised (March
2014) that Epiduo ® should be restricted for use in mild to
moderate facial acne when monotherapy with benzoyl
peroxide or adapalene is inappropriate.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Gel
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Disodium edetate, polysorbates, propylene
glycol
▶ Epiduo (Galderma (UK) Ltd)
Adapalene 1 mg per 1 gram, Benzoyl peroxide 25 mg per 1
gram Epiduo 0.1%/2.5% gel | 45 gram P £17.91
13
Skin
Isotretinoin
INDICATIONS AND DOSE
Topical treatment of mild to moderate acne
TO THE SKIN
▶ Adult: Apply 1–2 times a day, to be applied thinly
Severe acne (under expert supervision) | Acne which is
associated with psychological problems (under expert
supervision) | Acne which has not responded to an
adequate course of a systemic antibacterial (under expert
supervision) | Acne with scarring (under expert
supervision) | Systemic treatment of nodulo-cystic and
conglobate acne (under expert supervision)
BY MOUTH
▶ Adult: Initially 500 micrograms/kg daily in 1–2 divided
doses, increased if necessary to 1 mg/kg daily for
16–24 weeks, repeat treatment course after a period of
at least 8 weeks if relapse after first course; maximum
150 mg/kg per course
l CONTRA-INDICATIONS
▶ With oral use hyperlipidaemia . hypervitaminosis A
▶ With topical use perioral dermatitis . rosacea
l CAUTIONS
▶ With oral use avoid blood donation during treatment and for
at least 1 month after treatment . diabetes . dry eye
syndrome (associated with risk of keratitis) . history of
depression . monitor for depression
▶ With topical use allow peeling (resulting from other irritant
treatments) to subside before using a topical retinoid .
alternating a preparation that causes peeling with a topical
retinoid may give rise to contact dermatitis (reduce
frequency of retinoid application) . avoid accumulation in
angles of the nose . avoid contact with eyes, nostrils, mouth
and mucous membranes, eczematous, broken or sunburned
skin . avoid exposure to UV light (including sunlight,
solariums) . avoid in severe acne involving large areas . avoid
use of topical retinoids with abrasive cleaners, comedogenic
or astringent cosmetics . caution in sensitive areas such as
the neck . personal or familial history of non-melanoma skin
cancer
l INTERACTIONS
▶ With oral use → Appendix 1 (retinoids). Avoid keratolytics.
l SIDE-EFFECTS
▶ Common or very common
With oral use anaemia . arthralgia . dryness of eyes (with
▶
blepharitis and conjunctivitis) . dryness of lips (sometimes
cheilitis) . dryness of nasal mucosa (with epistaxis) .
dryness of pharyngeal mucosa (with hoarseness) . dryness
of skin (with dermatitis, scaling, thinning, erythema,
pruritus) . epidermal fragility (trauma may cause
 1046 Rosacea and acne
blistering) . haematuria . headache . myalgia . neutropenia
. proteinuria . raised blood-glucose concentration . raised
plasma-triglyceride concentration . raised serum-
cholesterol concentration (with reduced high-density
lipoprotein concentration) . raised serum-transaminase
concentration . thrombocytopenia . thrombocytosis
▶ Rare
▶ With oral use aggressive behaviour . alopecia . anxiety .
depression . mood changes . skin reactions
▶ Very rare
▶ With oral use acne fulminans . allergic vasculitis . arthritis
. benign intracranial hypertension . blurred vision . bone
changes following long-term administration . calcification
of tendons and ligaments following long-term
administration . cataracts . colour blindness . convulsions .
corneal opacities . decreased night vision . decreased
tolerance to contact lenses . diabetes mellitus . dizziness .
13 drowsiness . early epiphyseal closure following long-term
administration . exacerbation of acne . gastrointestinal
haemorrhage . glomerulonephritis . Gram-positive
Skin
infections of skin and mucous membranes .
granulomatous lesions . haemorrhagic diarrhoea .
hepatitis . hirsutism . hyperuricaemia . impaired hearing .
increased sweating . inflammatory bowel disease . keratitis
. lymphadenopathy . malaise . nail dystrophy . nausea .
papilloedema . paronychia . photophobia .
photosensitivity . psychosis . raised serum-creatine kinase
concentration . reduced bone density following long-term
administration . skeletal hyperostosis following long-term
administration . skin hyperpigmentation . suicidal
ideation . tendinitis . visual disturbances
▶ Frequency not known
▶ With oral use Stevens-Johnson syndrome . toxic epidermal
necrolysis
▶ With topical use blistering of skin . burning . crusting of
skin . dry or peeling skin . erythema . eye irritation .
increased sensitivity to UVB light or sunlight . oedema .
pruritus . stinging
SIDE-EFFECTS, FURTHER INFORMATION
Management of side-effects Risk of pancreatitis if
triglycerides above 9 mmol/litre—discontinue if
uncontrolled hypertriglyceridaemia or pancreatitis.
Psychiatric side-effects require expert referral.
Discontinue treatment if skin peeling severe or
haemorrhagic diarrhoea develops.
Visual disturbances require expert referral and possible
withdrawal.
l CONCEPTION AND CONTRACEPTION
▶ With oral use Effective contraception must be used. In
women of child-bearing potential, exclude pregnancy up
to 3 days before treatment (start treatment on day 2 or 3
of menstrual cycle), every month during treatment (unless
there are compelling reasons to indicate that there is no
risk of pregnancy), and 5 weeks after stopping
treatment—perform pregnancy test in the first 3 days of
the menstrual cycle. Women must practise effective
contraception for at least 1 month before starting
treatment, during treatment, and for at least 1 month
after stopping treatment. Women should be advised to
use at least 1 method of contraception, but ideally they
should use 2 methods of contraception. Oral progestogen-
only contraceptives are not considered effective. Barrier
methods should not be used alone, but can be used in
conjunction with other contraceptive methods. Each
prescription for isotretinoin should be limited to a supply
of up to 30 days’ treatment and dispensed within 7 days
of the date stated on the prescription; repeat
prescriptions or faxed prescriptions are not acceptable.
Women should be advised to discontinue treatment and
to seek prompt medical attention if they become pregnant
during treatment or within 1 month of stopping
treatment.
BNF 70
▶ With topical use Females of child-bearing age must use
effective contraception (oral progestogen-only
contraceptives not considered sufficiently effective).
l PREGNANCY Contra-indicated in pregnancy (teratogenic).
BREAST FEEDING Avoid.
l
l HEPATIC IMPAIRMENT
▶ With oral use Avoid—further impairment may occur.
l RENAL IMPAIRMENT
▶ With oral use In severe impairment, reduce initial dose
(e.g. 10 mg daily) and increase gradually up to 1 mg/kg
daily as tolerated.
l MONITORING REQUIREMENTS
▶ With oral use Measure hepatic function and serum lipids
before treatment, 1 month after starting and then every
3 months (reduce dose or discontinue if transaminase or
serum lipids persistently raised).
l PRESCRIBING AND DISPENSING INFORMATION Isotretinoin
is an isomer of tretinoin.
PATIENT AND CARER ADVICE
l
With oral use Warn patient to avoid wax epilation (risk of
▶
epidermal stripping), dermabrasion, and laser skin
treatments (risk of scarring) during treatment and for at
least 6 months after stopping; patient should avoid
exposure to UV light (including sunlight) and use
sunscreen and emollient (including lip balm) preparations
from the start of treatment. Patients and carers should be
told how to recognise signs and symptoms of psychiatric
disorders such as depression, anxiety, and rarely suicidal
thoughts.
▶ With topical use Patients should be warned that some
redness and skin peeling can occur initially but settles
with time. If undue irritation occurs, the frequency of
application should be reduced or treatment suspended
until the reaction subsides; if irritation persists,
discontinue treatment. Several months of treatment may
be needed to achieve an optimal response and the
treatment should be continued until no new lesions
develop. If sun exposure is unavoidable, an appropriate
sunscreen or protective clothing should be used.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Capsule
CAUTIONARY AND ADVISORY LABELS 10, 11, 21
▶ ISOTRETINOIN (Non-proprietary)
Isotretinoin 5 mg Isotretinoin 5mg capsules | 30 capsule P
£10.46 | 56 capsule P £14.78
Isotretinoin 10 mg Isotretinoin 10mg capsules | 30 capsule P
£14.54 DT price = £14.54
Isotretinoin 20 mg Isotretinoin 20mg capsules | 30 capsule P
£20.00 DT price = £19.55 | 56 capsule P £37.85
Isotretinoin 40 mg Isotretinoin 40mg capsules | 30 capsule P
£38.98 DT price = £38.98
▶ Roaccutane (Roche Products Ltd)
Isotretinoin 10 mg Roaccutane 10mg capsules | 30 capsule P
£14.54 DT price = £14.54
Isotretinoin 20 mg Roaccutane 20mg capsules | 30 capsule P
£20.02 DT price = £19.55
Gel
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Butylated hydroxytoluene
▶ Isotrex (Stiefel Laboratories (UK) Ltd)
Isotretinoin 500 microgram per 1 gram Isotrex 0.05% gel |
30 gram P £5.94 DT price = £5.94
 BNF 70
Isotretinoin with erythromycin
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, erythromycin p. 1043, isotretinoin p. 1045.
INDICATIONS AND DOSE
Topical treatment of mild to moderate acne
TO THE SKIN
▶ Adult: (consult product literature)
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Gel
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Butylated hydroxytoluene
▶ Isotrexin (Stiefel Laboratories (UK) Ltd)
Erythromycin 20 mg per 1 gram, Isotretinoin 500 microgram per
1 gram Isotrexin gel | 30 gram P £7.47 DT price = £7.47
Tretinoin with clindamycin
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, clindamycin p. 467, tretinoin p. 769.
INDICATIONS AND DOSE
Facial acne
TO THE SKIN
▶ Child 12–17 years: Apply daily, (to be applied thinly at
bedtime)
Adult: Apply daily, (to be applied thinly at bedtime)
▶
l CONTRA-INDICATIONS Perioral dermatitis . personal or
familial history of non-melanoma skin cancer . rosacea
CAUTIONS Allow peeling (resulting from other irritant
l
treatments) to subside before using a topical retinoid .
alternating a preparation that causes peeling with a
topical retinoid may give rise to contact dermatitis
(reduce frequency of retinoid application) . avoid
accumulation in angles of the nose . avoid contact with
eyes, nostrils, mouth and mucous membranes,
eczematous, broken or sunburned skin . avoid exposure to
UV light (including sunlight, solariums) . avoid in severe
acne involving large areas . avoid use of topical retinoids
with abrasive cleaners, comedogenic or astringent
cosmetics . caution in sensitive areas such as the neck
l SIDE-EFFECTS Blistering of skin . burning . crusting of skin
. dry or peeling skin (discontinue if severe) . erythema .
eye irritation . increased sensitivity to UVB light or
sunlight . oedema . pruritus . stinging . temporary changes
of skin pigmentation
l CONCEPTION AND CONTRACEPTION Females of child-
bearing age must use effective contraception (oral
progestogen-only contraceptives not considered
sufficiently effective).
l PREGNANCY Contra-indicated in pregnancy.
l BREAST FEEDING Amount of drug in milk after topical
application probably too small to be harmful; ensure
infant does not come in contact with treated areas.
l PATIENT AND CARER ADVICE If sun exposure is
unavoidable, an appropriate sunscreen or protective
clothing should be used. Patients and carers should be
warned that some redness and skin peeling can occur
initially but settles with time. If undue irritation occurs,
the frequency of application should be reduced or
treatment suspended until the reaction subsides; if
irritation persists, discontinue treatment. Several months
of treatment may be needed to achieve an optimal
Acne 1047
response and the treatment should be continued until no
new lesions develop.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Gel
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Butylated hydroxytoluene, hydroxybenzoates
(parabens), polysorbates
▶ Treclin (Meda Pharmaceuticals Ltd)
Clindamycin (as Clindamycin phosphate) 10 mg per 1 gram,
Tretinoin 250 microgram per 1 gram Treclin 1%/0.025% gel |
30 gram P £11.94
Tretinoin with erythromycin
The properties listed below are those particular to the
combination only. For the properties of the components please
13
consider, erythromycin p. 1043, tretinoin p. 769.
Skin
INDICATIONS AND DOSE
Acne
TO THE SKIN
▶ Child: Apply 1–2 times a day, apply thinly
▶ Adult: Apply 1–2 times a day, apply thinly
l CONTRA-INDICATIONS Perioral dermatitis . personal or
familial history of non-melanoma skin cancer . rosacea
l CAUTIONS Allow peeling (resulting from other irritant
treatments) to subside before using a topical retinoid .
alternating a preparation that causes peeling with a
topical retinoid may give rise to contact dermatitis
(reduce frequency of retinoid application) . avoid
accumulation in angles of the nose . avoid contact with
eyes, nostrils, mouth and mucous membranes,
eczematous, broken or sunburned skin . avoid exposure to
UV light (including sunlight, solariums) . avoid in severe
acne involving large areas . avoid use of topical retinoids
with abrasive cleaners, comedogenic or astringent
cosmetics . caution in sensitive areas such as the neck
l SIDE-EFFECTS Blistering of skin . burning . crusting of skin
. dry or peeling skin (discontinue if severe) . erythema .
eye irritation . increased sensitivity to UVB light or
sunlight . oedema . pruritus . stinging . temporary changes
of skin pigmentation
l CONCEPTION AND CONTRACEPTION Females of child-
bearing age must use effective contraception (oral
progestogen-only contraceptives not considered
sufficiently effective).
l PREGNANCY Contra-indicated in pregnancy.
l BREAST FEEDING Amount of drug in milk after topical
application probably too small to be harmful; ensure
infant does not come in contact with treated areas.
l PATIENT AND CARER ADVICE Patients and carers should be
warned that some redness and skin peeling can occur
initially but settles with time. If undue irritation occurs,
the frequency of application should be reduced or
treatment suspended until the reaction subsides; if
irritation persists, discontinue treatment. Several months
of treatment may be needed to achieve an optimal
response and the treatment should be continued until no
new lesions develop. If sun exposure is unavoidable, an
appropriate sunscreen or protective clothing should be
used.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
 1048 Scalp and hair conditions BNF 70

Liquid l PATIENT AND CARER ADVICE Drowsiness may affect

CAUTIONARY AND ADVISORY LABELS 11 performance of skilled tasks (e.g. driving).
▶ Aknemycin Plus (Almirall Ltd) Patients should be advised on administration of gel.
Erythromycin 40 mg per 1 gram, Tretinoin 250 microgram per 1
l NATIONAL FUNDING/ACCESS DECISIONS
gram Aknemycin Plus solution | 25 ml P £7.05 DT price = £7.05
Scottish Medicines Consortium (SMC) Decisions
VITAMIN B GROUP The Scottish Medicines Consortium has advised (December
2014) that brimonidine (Mirvaso ®) is accepted for
restricted use within NHS Scotland for the symptomatic
Nicotinamide treatment of moderate to severe persistent facial
INDICATIONS AND DOSE erythema associated with rosacea in adult patients.
Inflammatory acne vulgaris l MEDICINAL FORMS
TO THE SKIN There can be variation in the licensing of different medicines
▶ Adult: Apply twice daily, reduced if not tolerated to containing the same drug.
once daily or on alternate days, dose reduced if Gel
irritation occurs CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Hydroxybenzoates (parabens), propylene
13 l CAUTIONS Avoid contact with eyes . avoid contact with glycol
mucous membranes (including nose and mouth) . reduce ▶ Mirvaso (Galderma (UK) Ltd)
Brimonidine (as Brimonidine tartrate) 3 mg per 1 gram Mirvaso
Skin

frequency of application if excessive dryness, irritation or

3mg/g gel | 30 gram P £33.69
peeling
l SIDE-EFFECTS Burning . dry skin . erythema . irritation .

l
pruritus

MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Gel
▶ Nicam (Dermal Laboratories Ltd)
Nicotinamide 40 mg per 1 gram Nicam 4% gel | 60 gram
▶ Brands may include Freederm
7.2 Rosacea
Brimonidine tartrate
INDICATIONS AND DOSE
Facial erythema in rosacea
TO THE SKIN
▶ Adult: Apply once daily until erythema subsides, apply
thinly, divide dose over forehead, chin, nose, and
cheeks; maximum 5 mg per day
l CAUTIONS Cerebral insufficiency . coronary insufficiency .
depression . postural hypotension . Raynaud’s syndrome .
severe cardiovascular disease . thromboangitis obliterans
l INTERACTIONS → Appendix 1 (brimonidine).
l SIDE-EFFECTS
▶ Common or very common burning sensation at application
site . stinging at application site
▶ Uncommon Dry mouth, heachache, paraesthesia, skin
irritation, dry skin
l PREGNANCY Limited information available; manufacturer
advises avoid.
l BREAST FEEDING Manufacturer advises avoid—no
information available.
l HEPATIC IMPAIRMENT Manufacturer advises use with
caution.
l RENAL IMPAIRMENT Manufacturer advises use with
caution.
l DIRECTIONS FOR ADMINISTRATION Avoid contact with
eyes, mouth, and mucous membranes; avoid use on
irritated skin or open wounds; apply other topical
preparations (including cosmetics) only after brimonidine
gel has dried on skin.
8 Scalp and hair conditions
Scalp and hair conditions
Dandruff is considered to be a mild form of seborrhoeic
p £7.10
dermatitis. Shampoos containing antimicrobial agents such
as pyrithione zinc (which are widely available) and
selenium p. 1049 may have beneficial effects. Shampoos
containing tar extracts may be useful and they are also used
in psoriasis. Ketoconazole shampoo p. 1011 should be
considered for more persistent or severe dandruff or for
seborrhoeic dermatitis of the scalp.
Corticosteroid gels and lotions can also be used.
Shampoos containing coal tar with salicylic acid p. 1035
may also be useful. A cream or an ointment containing coal
tar with salicylic acid p. 1035 is very helpful in Psoriasis
p. 1017 that affects the scalp. Patients who do not respond
to these treatments may need to be referred to exclude the
possibility of other skin conditions.
Cradle cap in infants may be treated with coconut oil or
olive oil applications followed by shampooing.
Hirsutism
Hirsutism may result from hormonal disorders or as a side-
effect of drugs such as minoxidil p. 1049, corticosteroids,
anabolic steroids, androgens, danazol p. 636, and
progestogens.
Weight loss can reduce hirsutism in obese women.
Women should be advised about local methods of hair
removal, and in the mildest cases this may be all that is
required.
Eflornithine p. 1050 an antiprotozoal drug, inhibits the
enzyme ornithine decarboxylase in hair follicles. Topical
eflornithine can be used as an adjunct to laser therapy for
facial hirsutism in women.
Co-cyprindiol p. 1042 may be effective for moderately
severe hirsutism. Metformin hydrochloride p. 594 is an
alternative in women with polycystic ovary syndrome
[unlicensed indication]. Systemic treatment is required for
6–12 months before benefit is seen.
Androgenetic alopecia
Finasteride p. 676 is licensed for the treatment of
androgenetic alopecia in men. Continuous use for
3–6 months is required before benefit is seen, and effects
are reversed 6–12 months after treatment is discontinued.
Topical application of minoxidil p. 1049 may stimulate
limited hair growth in a small proportion of adults but only
for as long as it is used.
 BNF 70 Alopecia 1049

ANTISEPTICS AND DISINFECTANTS Shampoo

EXCIPIENTS: May contain Fragrances
Selsun (Chattem (U.K.) Ltd)
Benzalkonium chloride ▶
Selenium sulfide 25 mg per 1 ml Selsun 2.5% shampoo | 50 ml p
£1.44 DT price = £1.44 | 100 ml p £1.96 DT price = £1.96 |
INDICATIONS AND DOSE 150 ml p £2.75 DT price = £2.75
Seborrhoeic scalp conditions associated with dandruff and
scaling
TO THE SKIN
▶
▶
Child: Apply as required
Adult: Apply as required
8.1 Alopecia
PERIPHERAL VASODILATORS
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
Minoxidil
manufacturers include: liquid
INDICATIONS AND DOSE
Shampoo
Dermax (Dermal Laboratories Ltd) REGAINE ® FOR MEN EXTRA STRENGTH FOAM
▶
Benzalkonium chloride 5 mg per 1 ml Dermax Therapeutic 0.5% Androgenetic alopecia 13
shampoo | 250 ml p £5.69 TO THE SKIN

Skin
▶ Adult: Apply 0.5 capful twice daily, to be applied to the
affected areas of scalp; discontinue if no improvement
Cetrimide with undecenoic acid after 16 weeks
REGAINE ® FOR MEN EXTRA STRENGTH SOLUTION
INDICATIONS AND DOSE
Androgenetic alopecia
Scalp psoriasis | Seborrhoeic dermatitis | Dandruff TO THE SKIN
TO THE SKIN ▶ Adult: Apply 1 mL twice daily, to be applied to the
▶ Child: Apply 3 times a week for 1 week, then apply affected areas of scalp; discontinue if no improvement
twice weekly after 1 year
▶ Adult: Apply 3 times a week for 1 week, then apply REGAINE ® FOR WOMEN REGULAR STRENGTH
twice weekly
Androgenetic alopecia
TO THE SKIN
l MEDICINAL FORMS ▶ Adult: Apply 1 mL twice daily, to be applied to the
There can be variation in the licensing of different medicines affected areas of scalp; discontinue if no improvement
containing the same drug.
after 1 year
Shampoo
▶ Ceanel (Alliance Pharmaceuticals Ltd)
l CONTRA-INDICATIONS Phaeochromocytoma
Cetrimide 100 mg per 1 ml, Phenylethyl alcohol 75 mg per 1 ml,
Undecenoic acid 10 mg per 1 ml Ceanel Concentrate shampoo | l CAUTIONS Avoid contact with broken, infected, shaved, or
150 ml p £3.40 | 500 ml p £9.80 inflamed skin . avoid contact with eyes . avoid contact
with mouth . avoid contact with mucous membranes .
ESSENTIAL TRACE ELEMENTS avoid inhalation of spray mist . avoid occlusive dressings
CAUTIONS, FURTHER INFORMATION
Selenium When used topically systemic effects unlikely; only about
1–2% absorbed (greater absorption may occur with use on
INDICATIONS AND DOSE inflamed skin).
Seborrhoeic dermatitis | Dandruff l INTERACTIONS Caution—avoid topical drugs which
TO THE SKIN enhance absorption.
▶ Child 5–17 years: Apply twice weekly for 2 weeks, then l SIDE-EFFECTS
apply once weekly for 2 weeks, then apply as required ▶ Common or very common Headache . local irritation
▶ Adult: Apply twice weekly for 2 weeks, then apply once ▶ Uncommon Changes in hair colour or texture (discontinue
weekly for 2 weeks, then apply as required if increased hair loss persists for more than 2 weeks) .
Pityriasis versicolor hypotension
TO THE SKIN SIDE-EFFECTS, FURTHER INFORMATION
▶ Adult: Apply daily for 7 days, apply to the affected area When used topically systemic effects unlikely; only about
and leave on for 10 minutes before rinsing off. The 1–2% absorbed (greater absorption may occur with use on
course may be repeated if necessary. Diluting with a inflamed skin).
small amount of water prior to application can reduce l PREGNANCY Avoid—possible toxicity including reduced
irritation placental perfusion. Neonatal hirsutism reported.
l BREAST FEEDING Present in milk but not known to be
l UNLICENSED USE The use of selenium sulfide shampoo as
a lotion for the treatment of pityriasis (tinea) versicolor is harmful.
an unlicensed indication. l PATIENT AND CARER ADVICE Ensure hair and scalp dry

l PATIENT AND CARER ADVICE Avoid using 48 hours before
or after applying hair colouring, straightening or waving
preparations.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
before application. Patients and their carers should be
advised to wash hands after application of liquid or foam.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
 1050 Skin cleansers, antiseptics and desloughing agents
Foam
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Butylated hydroxytoluene, cetostearyl alcohol
(including cetyl and stearyl alcohol), polysorbates
Regaine (McNeil Products Ltd)
▶
Minoxidil 50 mg per 1 gram Regaine for Men Extra Strength 5%
scalp foam | 60 gram G £21.84 | 180 gram p £46.83
Liquid
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Propylene glycol
▶ Regaine (McNeil Products Ltd)
Minoxidil 20 mg per 1 ml Regaine for Women Regular Strength 2%
solution | 60 ml G £14.16
Minoxidil 50 mg per 1 ml Regaine for Men Extra Strength 5%
solution | 60 ml G £19.84 | 180 ml p £39.71
13 8.2 Hirsutism
Skin
Eflornithine
l DRUG ACTION An antiprotozoal drug that inhibits the
enzyme ornithine decarboxylase in hair follicles.
INDICATIONS AND DOSE
Adjunct to laser therapy for facial hirsutism in women
TO THE SKIN
▶ Adult: Apply twice daily, to be applied thinly,
discontinue use if no improvement after 4 months of
treatment
l SIDE-EFFECTS
▶ Common or very common Acne . burning at application
site . rash . stinging at application site
▶ Uncommon Abnormal hair growth . abnormal hair texture
l PREGNANCY Toxicity in animal studies—manufacturer
advises avoid.
l BREAST FEEDING Manufacturer advises avoid—no
information available.
l PATIENT AND CARER ADVICE Medicines must be rubbed in
thoroughly. Cosmetics may be applied over treated area
5 minutes after eflornithine, do not wash treated area for
4 hours after application.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
The Scottish Medicines Consortium has advised (September
2005) that eflornithine for facial hirsutism be restricted
for use in women in whom alternative drug treatment
cannot be used.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens)
▶ Vaniqa (Almirall Ltd)
Eflornithine (as Eflornithine monohydrate chloride) 115 mg per 1
gram Vaniqa 11.5% cream | 60 gram P £56.87 DT price = £56.87
BNF 70
9 Skin cleansers,
antiseptics and
desloughing agents
Skin cleansers, antiseptics and
desloughing agents
Soap or detergent is used with water to cleanse intact skin;
emollient preparations such as aqueous cream or
emulsifying ointment can be used in place of soap or
detergent for cleansing dry skin.
An antiseptic is used for skin that is infected or that is
susceptible to recurrent infection. Detergent preparations
containing chlorhexidine p. 1051 or povidone-iodine
p. 1053, which should be thoroughly rinsed off, are used.
Emollients may also contain antiseptics.
Antiseptics such as chlorhexidine or povidone-iodine are
used on intact skin before surgical procedures; their
antiseptic effect is enhanced by an alcoholic solvent.
Antiseptic solutions containing cetrimide can be used if a
detergent effect is also required.
Hydrogen peroxide p. 1052, an oxidising agent, can be
used in solutions of up to 6% for skin disinfection, such as
cleansing and deodorising wounds and ulcers. Hydrogen
peroxide is also available as a cream for superficial bacterial
skin infections.
For irrigating ulcers or wounds, lukewarm sterile sodium
chloride 0.9% solution is used, but tap water is often
appropriate.
Potassium permanganate solution 1 in 10000 p. 1052, a
mild antiseptic with astringent properties, can be used for
exudative eczematous areas; treatment should be stopped
when the skin becomes dry.
Desloughing agents
Alginate, hydrogel and hydrocolloid dressings are effective
at wound debridement. Sterile larvae (maggots) (available
from BioMonde) are also used for managing sloughing
wounds and are prescribable on the NHS.
Desloughing solutions and creams are of little clinical
value. Substances applied to an open area are easily
absorbed and perilesional skin is easily sensitised.
Gravitational dermatitis may be complicated by
superimposed contact sensitivity to substances such as
neomycin sulfate p. 1009 or lanolin.
ALCOHOLS
Industrial methylated spirit
(Alcohol)
INDICATIONS AND DOSE
Skin preparation before injection
TO THE SKIN
▶ Child: Apply as required
▶ Adult: Apply as required
l CONTRA-INDICATIONS Neonates
l CAUTIONS Avoid broken skin . flammable . patients have
suffered severe burns when diathermy has been preceded
by application of alcoholic skin disinfectants
l INTERACTIONS For the interactions following the ingestion
of alcohol, see Appendix 1 (alcohol).
l SIDE-EFFECTS
Overdose Features of acute alcohol intoxication include
ataxia, dysarthria, nystagmus, and drowsiness, which may
progress to coma, with hypotension and acidosis.
 BNF 70 Skin cleansers, antiseptics and desloughing agents 1051

For details on the management of poisoning, see Alcohol, HYDREX ® SOLUTION

under Emergency treatment of poisoning p. 1123. For pre-operative skin disinfection
l PRESCRIBING AND DISPENSING INFORMATION When TO THE SKIN
prepared extemporaneously, the BP states Surgical Spirit, ▶ Child: (consult product literature)
BP consists of methyl salicylate 0.5 mL, diethyl phthalate ▶ Adult: (consult product literature)
2%, castor oil 2.5%, in industrial methylated spirit. HYDREX ® SURGICAL SCRUB
l MEDICINAL FORMS For pre-operative hand and skin disinfection | General hand
There can be variation in the licensing of different medicines disinfection
containing the same drug. TO THE SKIN
Liquid ▶ Child: (consult product literature)
▶ ALCOHOL (Non-proprietary) ▶ Adult: (consult product literature)
Industrial methylated spirit 70% | 600 ml £5.71 UNISEPT ®
Ethanol 950 ml per 1 litre, Wood naphtha 50 ml per 1
litre Industrial methylated spirit 95% | 600 ml £5.82 | 1000 ml For cleansing and disinfecting wounds and burns and
£4.29–£6.02 swabbing in obstetrics
TO THE SKIN
ANTISEPTICS AND DISINFECTANTS ▶ Child: (consult product literature)
▶ Adult: (consult product literature) 13
Chlorhexidine

Skin
l CONTRA-INDICATIONS Alcoholic solutions not suitable
INDICATIONS AND DOSE before diathermy . alcoholic solutions not suitable for use
CEPTON ® LOTION on neonatal skin . not for use in body cavities
For skin disinfection in acne l CAUTIONS Avoid contact with brain . avoid contact with
TO THE SKIN eyes . avoid contact with meninges . avoid contact with
▶ Child: (consult product literature) middle ear
▶ Adult: (consult product literature) l SIDE-EFFECTS Chemical burns in preterm neonates .
CEPTON ® SKIN WASH sensitivity
For use as skin wash in acne l DIRECTIONS FOR ADMINISTRATION
TO THE SKIN HIBITANE ® PLUS 5% CONCENTRATE SOLUTION
▶ Child: (consult product literature) For pre-operative skin preparation, dilute 1 in 10 (0.5%)
▶ Adult: (consult product literature) with alcohol 70%. For general skin disinfection, dilute
CHLORAPREP ®
1 in 100 (0.05%) with water. Alcoholic solutions not
suitable for use before diathermy or on neonatal skin.
For skin disinfection before invasive procedures
TO THE SKIN l MEDICINAL FORMS
▶ Child 2 months–17 years: (consult product literature) There can be variation in the licensing of different medicines
▶ Adult: (consult product literature) containing the same drug. Forms available from special-order
manufacturers include: liquid
CX ANTISEPTIC DUSTING POWDER
Liquid
For skin disinfection CAUTIONARY AND ADVISORY LABELS 15
TO THE SKIN EXCIPIENTS: May contain Fragrances
▶ Adult: (consult product literature) ▶ CHLORHEXIDINE (Non-proprietary)
HIBI ® LIQUID HAND RUB+ Chlorhexidine gluconate 500 microgram per 1 ml Chlorhexidine
gluconate 0.05% solution 100ml sachets | 10 sachet p no price
Hand and skin disinfection available
TO THE SKIN ▶ Cepton (Boston Healthcare Ltd)
▶ Child: To be used undiluted (consult product literature) Chlorhexidine gluconate 10 mg per 1 ml Cepton 1% medicated
▶ Adult: To be used undiluted (consult product skin wash | 150 ml G £5.10
literature) ▶ HiBiTane Plus (Molnlycke Health Care Ltd)
Chlorhexidine gluconate 50 mg per 1 ml HiBiTane Plus 5%
HIBISCRUB ®
concentrate solution | 5000 ml G £14.50
Pre-operative hand and skin disinfection | General hand and ▶ Hibi (Molnlycke Health Care Ltd)
skin disinfection Chlorhexidine gluconate 5 mg per 1 ml HiBi Liquid Hand Rub+
TO THE SKIN 0.5% solution | 500 ml G £5.25
▶ Child: Use as alternative to soap (consult product ▶ Hibiscrub (Molnlycke Health Care Ltd)
literature) Chlorhexidine gluconate 40 mg per 1 ml Hibiscrub 4% solution |
▶ Adult: Use as alternative to soap (consult product
250 ml G £4.25 | 500 ml G £5.25 | 5000 ml G £24.00
▶ Hydrex (Ecolab Healthcare Division)
literature)
Chlorhexidine gluconate 5 mg per 1 ml Hydrex pink chlorhexidine
HIBITANE ® PLUS 5% CONCENTRATE SOLUTION gluconate 0.5% solution | 600 ml G £3.49
General and pre-operative skin disinfection Hydrex clear chlorhexidine gluconate 0.5% solution | 600 ml G
TO THE SKIN £3.49
Chlorhexidine gluconate 40 mg per 1 ml Hydrex 4% Surgical
▶ Child: (consult product literature) Scrub | 250 ml G £3.39 | 500 ml G £3.59 | 5000 ml G
HIBITANE OBSTETRIC ® £26.96
For use in obstetrics and gynaecology as an antiseptic and Cream
lubricant ▶ CHLORHEXIDINE (Non-proprietary)
TO THE SKIN Chlorhexidine hydrochloride 5 mg per 1 gram | 30 gram G
▶ Adult: To be applied to skin around vulva and £2.07
▶ Brands may include Acriflex, Eczmol, Hibitane
perineum and to hands of midwife or doctor
Gel
▶ Cepton (Boston Healthcare Ltd)
Chlorhexidine gluconate 5 mg per 1 gram Cepton 0.5% medicated
clear gel | 30 gram G £2.97
 1052 Skin cleansers, antiseptics and desloughing agents
Irrigation solution
▶ CHLORHEXIDINE (Non-proprietary)
Chlorhexidine acetate 200 microgram per 1 ml Chlorhexidine
acetate 0.02% irrigation solution 1litre bottles | 1 bottle p no price
available
Chlorhexidine acetate 500 microgram per 1 ml Chlorhexidine
acetate 0.05% irrigation solution 1litre bottles | 1 bottle p no price
available
Powder
▶ CX Antiseptic Dusting Powder (Ecolab Healthcare Division)
Chlorhexidine acetate 10 mg per 1 gram CX 1% powder |
15 gram G £3.93
Chlorhexidine gluconate with isopropyl
alcohol
The properties listed below are those particular to the
13 combination only. For the properties of the components please
consider, chlorhexidine p. 1051.
Skin
INDICATIONS AND DOSE
Skin disinfection before invasive procedures
TO THE SKIN
▶ Child 2 months–17 years: (consult product literature)
▶ Adult: (consult product literature)
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
CAUTIONARY AND ADVISORY LABELS 15
▶ ChloraPrep (CareFusion U.K. Ltd)
Chlorhexidine gluconate 20 mg per 1 ml, Isopropyl alcohol 700
ml per 1 litre ChloraPrep with Tint solution 10.5ml applicators |
25 applicator G £76.65
ChloraPrep with Tint solution 26ml applicators | 25 applicator G
£170.75
ChloraPrep solution 3ml applicators | 25 applicator G £21.25
ChloraPrep solution 1.5ml applicators | 20 applicator G £11.00
ChloraPrep with Tint solution 3ml applicators | 25 applicator G
£22.31
ChloraPrep solution 0.67ml applicators | 200 applicator G £60.00
ChloraPrep solution 10.5ml applicators | 25 applicator G £73.00
ChloraPrep solution 26ml applicators | 25 applicator G £162.50
Hydrogen peroxide
l DRUG ACTION Hydrogen peroxide is an oxidising agent.
INDICATIONS AND DOSE
For skin disinfection, particularly cleansing and deodorising
wounds and ulcers
TO THE SKIN
▶ Adult: Use 3% and 6% solutions (consult product
literature)
CRYSTACIDE ®
Superficial bacterial skin infection
TO THE SKIN
▶ Child: Apply 2–3 times a day for up to 3 weeks
▶ Adult: Apply 2–3 times a day for up to 3 weeks
l CONTRA-INDICATIONS Closed body cavities . deep wounds
. large wounds . use as disinfection agent for surgical
instruments . use as enema . use during surgery
l CAUTIONS Avoid on eyes . avoid on healthy skin .
incompatible with products containing iodine or
potassium permanganate
l PRESCRIBING AND DISPENSING INFORMATION The BP
directs that when hydrogen peroxide is prescribed,
hydrogen peroxide solution 6% (20 vols) should be
dispensed. Strong solutions of hydrogen peroxide which
contain 27% (90 vols) and 30% (100 vols) are only for the
BNF 70
preparation of weaker solutions. When prepared
extemporaneously, the BP states Hydrogen Peroxide
Solution, BP consists of hydrogen peroxide 6% (20 vols) or
hydrogen peroxide 3% (10 vols).
l HANDLING AND STORAGE Hydrogen peroxide bleaches
fabric.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: liquid
Liquid
▶ HYDROGEN PEROXIDE (Non-proprietary)
Hydrogen peroxide 60 mg per 1 ml Hydrogen peroxide 6%
solution | 200 ml G £0.57 | 500 ml G £2.47 | 2000 ml G
£7.52
Hydrogen peroxide 90 mg per 1 ml Hydrogen peroxide 9%
solution | 200 ml G £0.61–£0.62
Hydrogen peroxide 30 ml per 1 litre Hydrogen peroxide 3%
solution | 200 ml G £0.55
Cream
EXCIPIENTS: May contain Edetic acid (edta), propylene glycol
▶ Crystacide (Derma UK Ltd)
Hydrogen peroxide 10 mg per 1 gram Crystacide 1% cream |
25 gram p £8.07 DT price = £8.07 | 40 gram p £11.62
Proflavine
INDICATIONS AND DOSE
Infected wounds | Infected burns
TO THE SKIN
▶ Adult: (consult product literature)
l PATIENT AND CARER ADVICE Stains clothing.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: liquid
ASTRINGENTS
Potassium permanganate
INDICATIONS AND DOSE
Cleansing and deodorising suppurating eczematous
reactions and wounds
TO THE SKIN
▶ Adult: For wet dressings or baths, use approximately
0.01% (1 in 10 000) solution
l CAUTIONS Irritant to mucous membranes
l DIRECTIONS FOR ADMINISTRATION Potassium
permanganate 0.1% solution to be diluted 1 in 10 to
provide a 0.01% (1 in 10 000) solution. With potassium
permanganate tablets for solution, 1 tablet dissolved in
4 litres of water provides a 0.01% (1 in 10 000) solution.
l PATIENT AND CARER ADVICE Can stain clothing, skin and
nails (especially with prolonged use).
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: liquid
Tablet for cutaneous solution
▶ POTASSIUM PERMANGANATE (Non-proprietary)
Potassium permanganate 400 mg Potassium permanganate
400mg tablets for cutaneous solution | 30 tablet no price available
DT price = £15.95
EN-Potab 400mg tablets for cutaneous solution | 30 tablet no price
available DT price = £15.95
▶ Permitabs (Alliance Pharmaceuticals Ltd)
Potassium permanganate 400 mg Permitabs 400mg tablets for
cutaneous solution | 30 tablet £15.95 DT price = £15.95
 BNF 70 Skin cleansers, antiseptics and desloughing agents 1053

IODINE PRODUCTS Povidone-Iodine 100 mg per 1 ml Videne 10% antiseptic

solution | 500 ml G £5.43
Povidone-iodine Spray
▶ Betadine (J M Loveridge Ltd)
INDICATIONS AND DOSE Povidone-Iodine 25 mg per 1 gram Betadine 2.5% dry powder
spray | 100 ml G £3.05 DT price = £3.05
Skin disinfection ▶ Savlon Dry (Novartis Consumer Health UK Ltd)
TO THE SKIN Povidone-Iodine 11.4 mg per 1 gram Savlon Dry 1.14% spray |
▶ Child: (consult product literature) 50 ml G £2.51 DT price = £2.51
▶ Adult: (consult product literature) Impregnated dressing
BETADINE ® DRY POWDER SPRAY ▶ POVIDONE-IODINE (Non-proprietary)
Povidone-Iodine 100 mg per 1 gram Povitulle dressing 9.5cm x
Skin disinfection, particularly minor wounds and infections 9.5cm | 1 dressing £0.42 | 10 dressing no price available
TO THE SKIN Povitulle dressing 5cm x 5cm | 1 dressing £0.28 | 25 dressing no
▶ Adult: Not for use in serous cavities (consult product price available
literature) ▶ Inadine (Systagenix Wound Management Ltd)
SAVLON ® DRY Povidone-Iodine 100 mg per 1 gram Inadine dressing 5cm x
5cm | 1 dressing £0.33 | 25 dressing no price available
Skin disinfection of minor wounds Inadine dressing 9.5cm x 9.5cm | 1 dressing £0.49 | 10 dressing no
TO THE SKIN price available
13
▶ Adult: (consult product literature)

VIDENE ® SOLUTION
Skin disinfection
TO THE SKIN
Child: Apply undiluted in pre-operative skin
▶
disinfection and general antisepsis
▶ Adult: Apply undiluted in pre-operative skin
disinfection and general antisepsis
VIDENE ® SURGICAL SCRUB ®
Skin disinfection
TO THE SKIN
▶ Child: Use as a pre-operative scrub for hand and skin
disinfection
▶ Adult: Use as a pre-operative scrub for hand and skin
disinfection
VIDENE ® TINCTURE
Skin disinfection
TO THE SKIN
▶ Adult: Apply undiluted in pre-operative skin
disinfection
l CONTRA-INDICATIONS Avoid regular use in patients with
thyroid disorders . concomitant use of lithium . corrected
gestational age under 32 weeks . infants body-weight
under 1.5 kg . regular use in neonates
l CAUTIONS Broken skin . large open wounds
CAUTIONS, FURTHER INFORMATION
Large open wounds The application of povidone–iodine to
large wounds or severe burns may produce systemic
adverse effects such as metabolic acidosis,
hypernatraemia and impairment of renal function.
VIDENE ® TINCTURE
Procedures involving hot wire cautery and diathermy
l SIDE-EFFECTS
▶ Rare Sensitivity
l PREGNANCY Sufficient iodine may be absorbed to affect
the fetal thyroid in the second and third trimester.
l BREAST FEEDING Avoid regular or excessive use.
l RENAL IMPAIRMENT Avoid regular application to inflamed
or broken skin or mucosa.
l EFFECT ON LABORATORY TESTS May interfere with thyroid
function tests.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: liquid
Liquid
CAUTIONARY AND ADVISORY LABELS 15
▶ Videne (Ecolab Healthcare Division)
Povidone-Iodine 75 mg per 1 ml Videne 7.5% surgical scrub
solution | 500 ml p £5.43
Skin
SKIN CLEANSERS
Diethyl phthalate with methyl
salicylate
INDICATIONS AND DOSE
Skin preparation before injection
TO THE SKIN
▶ Adult: Apply, to the area to be disinfected
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
CAUTIONARY AND ADVISORY LABELS 15
▶ DIETHYL PHTHALATE WITH METHYL SALICYLATE (Non-
proprietary)
Castor oil 25 ml per 1 litre, Diethyl phthalate 20 ml per 1 litre,
Industrial methylated spirit 950 ml per 1 litre, Methyl salicylate
5 ml per 1 litre Surgical spirit | 200 ml G £1.06 DT price =
£1.06 | 500 ml G £1.89–£1.90 | 1000 ml G £3.26
Irrigation solutions
l IRRIGATION SOLUTIONS
▶ Flowfusor sodium chloride 0.9% irrigation solution 120ml
bottles (Fresenius Kabi Ltd)
1 bottle . NHS indicative price = £1.53 . Drug Tariff (Part IXa)
▶ Irriclens sodium chloride 0.9% irrigation solution aerosol spray
(ConvaTec Ltd)
240 ml . NHS indicative price = £3.49 . Drug Tariff (Part IXa)
▶ Normasol sodium chloride 0.9% irrigation solution 100ml
sachets (Molnlycke Health Care Ltd)
10 unit dose . NHS indicative price = £7.80 . Drug Tariff (Part IXa)
▶ Normasol sodium chloride 0.9% irrigation solution 25ml sachets
(Molnlycke Health Care Ltd)
25 unit dose . NHS indicative price = £6.42 . Drug Tariff (Part IXa)
▶ Sodium chloride 0.9% irrigation solution 20ml Clinipod unit
dose (Mayors Healthcare Ltd)
25 unit dose . NHS indicative price = £4.95 . Drug Tariff (Part IXa)
▶ Sodium chloride 0.9% irrigation solution 20ml ISO-POD unit
dose (St Georges Medical Ltd)
25 unit dose . NHS indicative price = £4.95 . Drug Tariff (Part IXa)
▶ Sodium chloride 0.9% irrigation solution 20ml Irripod unit dose
(C D Medical Ltd)
25 unit dose . NHS indicative price = £5.84 . Drug Tariff (Part IXa)
▶ Sodium chloride 0.9% irrigation solution 20ml Sal-e Pods unit
dose (Ennogen Healthcare Ltd)
25 unit dose . NHS indicative price = £7.91 . Drug Tariff (Part IXa)
▶ Sodium chloride 0.9% irrigation solution 20ml Steripod unit
dose (Molnlycke Health Care Ltd)
25 unit dose . NHS indicative price = £7.90 . Drug Tariff (Part IXa)
 1054 Skin cleansers, antiseptics and desloughing agents
▶ Sodium chloride 0.9% irrigation solution 20ml Sterowash unit
dose (Steroplast Healthcare Ltd)
25 unit dose . NHS indicative price = £5.40 . Drug Tariff (Part IXa)
▶ Stericlens sodium chloride 0.9% irrigation solution aerosol
spray (C D Medical Ltd)
100 ml . NHS indicative price = £2.07 . Drug Tariff (Part IXa)240 ml .
NHS indicative price = £3.15 . Drug Tariff (Part IXa)
9.1 Minor cuts and abrasions
Minor cuts and abrasions
Many preparations traditionally used to manage minor
burns, and abrasions have fallen out of favour. Preparations
13 containing camphor and sulfonamides should be avoided.
Preparations such as magnesium sulfate paste are now
rarely used to treat carbuncles and boils as these are best
Skin
treated with antibiotics.
Cetrimide is used to treat minor cuts and abrasions and
proflavine p. 1052 may be used to treat infected wounds or
burns, but its use has now been largely superseded by other
antispetics or suitable antibacterials. The effervescent effect
of hydrogen peroxide p. 1052 is used to clean minor cuts
and abrasions. When prepared extemporaneously, the BP
states Cetrimide Cream 0.5% in a suitable water-miscible
basis such as cetostearyl alcohol 5%, consists of liquid
paraffin 50% in freshly boiled and cooled purified water.
Flexible colloidon (see castor oil with collodion and
colophony below) may be used to seal minor cuts and
wounds that have partially healed; skin tissue adhesives are
used similarly, and also for additional suture support.
ANTISEPTICS AND DISINFECTANTS
Cetrimide with chlorhexidine
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, chlorhexidine p. 1051.
INDICATIONS AND DOSE
Skin disinfection such as wound cleansing and obstetrics
TO THE SKIN
▶ Child: To be used undiluted
▶ Adult: To be used undiluted
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Liquid
▶ Sterets Tisept (Molnlycke Health Care Ltd)
Cetrimide 1.5 mg per 1 ml, Chlorhexidine gluconate 150
microgram per 1 ml Sterets Tisept solution 25ml sachets |
25 sachet p £5.33
Sterets Tisept solution 100ml sachets | 10 sachet p £6.85
▶ Brands may include Savlon disinfectant
Cream
▶ CETRIMIDE WITH CHLORHEXIDINE (Non-proprietary)
Cetrimide 5 mg per 1 gram, Chlorhexidine gluconate 1 mg per 1
gram | 15 gram G £0.86 | 30 gram G £1.14 |
60 gram G £1.82 | 100 gram G £2.65
Irrigation solution
▶ CETRIMIDE WITH CHLORHEXIDINE (Non-proprietary)
Cetrimide 1.5 mg per 1 ml, Chlorhexidine acetate 150 microgram
per 1 ml Chlorhexidine acetate 0.015% / Cetrimide 0.15% irrigation
solution 1litre bottles | 1 bottle p no price available
BNF 70
COLLODIONS
Castor oil with collodion and colophony
INDICATIONS AND DOSE
Used to seal minor cuts and wounds that have partially
healed
TO THE SKIN
▶ Child: (consult product literature)
▶ Adult: (consult product literature)
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated if
patient has an allergy to colophony in elastic adhesive
plasters and tape.
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Collodion,
Flexible, BP consists of castor oil 2.5%, colophony 2.5% in
a collodion basis, prepared by dissolving pyroxylin (10%)
in a mixture of 3 volumes of ether and 1 volume of
alcohol (90%).
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Not applicable
▶ CASTOR OIL WITH COLLODION AND COLOPHONY (Non-
proprietary)
Castor oil 25 mg per 1 ml, Collodion methylated 950 microlitre
per 1 ml, Colophony 25 mg per 1 ml Flexible collodion
methylated | 100 ml £13.40 DT price = £9.04 | 500 ml £14.08–£27.25
MAGNESIUM
Glycerol with magnesium sulfate and
phenol
INDICATIONS AND DOSE
Treat carbuncles and boils
TO THE SKIN
▶ Adult: To be applied under dressing
l DIRECTIONS FOR ADMINISTRATION Paste should be stirred
before use.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Paste
▶ GLYCEROL WITH MAGNESIUM SULFATE AND PHENOL (Non-
proprietary)
Glycerol 550 mg per 1 gram, Magnesium sulfate dried 450 mg
per 1 gram, Phenol 5 mg per 1 gram Magnesium sulfate paste |
25 gram G £1.05 | 50 gram G £2.07 DT price = £2.07
Skin adhesives
l SKIN ADHESIVES
▶ Derma+Flex skin adhesive (Chemence Ltd)
.5 ml . NHS indicative price = £5.36 . Drug Tariff (Part IXa)
▶ Dermabond ProPen skin adhesive (Ethicon Ltd)
.5 ml . NHS indicative price = £19.08 . Drug Tariff (Part IXa)
▶ Histoacryl L skin adhesive (B.Braun Medical Ltd)
.2 gram . NHS indicative price = £6.20 . Drug Tariff (Part IXa).5 gram .
NHS indicative price = £6.72 . Drug Tariff (Part IXa)
▶ Histoacryl skin adhesive (B.Braun Medical Ltd)
.2 gram . NHS indicative price = £6.41 . Drug Tariff (Part IXa).5 gram .
NHS indicative price = £6.50 . Drug Tariff (Part IXa)
▶ Indermil skin adhesive (Covidien (UK) Commercial Ltd)
.5 gram . NHS indicative price = £6.50 . Drug Tariff (Part IXa)
▶ LiquiBand flow control tissue adhesive (MedLogic Global Ltd)
.5 gram . NHS indicative price = £5.50 . Drug Tariff (Part IXa)
▶ LiquiBand tissue adhesive (MedLogic Global Ltd)
.5 gram . NHS indicative price = £5.50 . Drug Tariff (Part IXa)
 BNF 70
10 Skin disfigurement
Camouflagers
Disfigurement of the skin can be very distressing to patients
and may have a marked psychological effect. In skilled
hands, or with experience, camouflage cosmetics can be
very effective in concealing scars and birthmarks. The
depigmented patches in vitiligo are also very disfiguring and
camouflage creams are of great cosmetic value.
Opaque cover foundation or cream is used to mask skin
pigment abnormalities; careful application using a
combination of dark- and light-coloured cover creams set
with powder helps to minimise the appearance of skin
deformities.
Borderline substances
The preparations marked ‘ACBS’ cannot be prescribed on
the NHS for postoperative scars and other deformities
except as adjunctive therapy in the relief of emotional
disturbances due to disfiguring skin disease, such as vitiligo.
Camouflages
l CAMOUFLAGES
▶ Covermark classic foundation (Derma UK Ltd)
15 ml (ACBS) . NHS indicative price = £11.86 (22 shades)
▶ Covermark finishing powder (Derma UK Ltd)
25 gram (ACBS) . NHS indicative price = £11.86
▶ Covermark removing cream (Camouflage Cosmetics Ltd)
200 ml . No NHS indicative price available
▶ Dermablend Dermasmooth Corrective Foundation (Vichy)
30 ml . No NHS indicative price available (12 shades)
▶ Dermacolor Creme Effectiv (Charles H Fox Ltd)
50 ml . NHS indicative price = £5.48
▶ Dermacolor body cover (Charles H Fox Ltd)
75 ml . No NHS indicative price available (51 shades)
▶ Dermacolor camouflage creme (Charles H Fox Ltd)
25 ml (ACBS) . NHS indicative price = £10.52 (150 shades)
▶ Dermacolor cleansing cream (Charles H Fox Ltd)
75 gram . No NHS indicative price available
▶ Dermacolor fixing powder (Charles H Fox Ltd)
60 gram (ACBS) . NHS indicative price = £9.05 (8 shades)
▶ Keromask finishing powder (Bellava Ltd)
20 gram (ACBS) . NHS indicative price = £5.68 (28 shades)
▶ Veil cleansing cream (Thomas Blake Cosmetic Creams Ltd)
50 gram . NHS indicative price = £2.45100 gram . NHS indicative price
= £4.00
▶ Veil cover cream (Thomas Blake Cosmetic Creams Ltd)
19 gram (ACBS) . NHS indicative price = £22.4244 gram (ACBS) . NHS
indicative price = £33.3570 gram (ACBS) . NHS indicative price =
£42.10 (40 shades)
▶ Veil finishing powder (Thomas Blake Cosmetic Creams Ltd)
35 gram (ACBS) . NHS indicative price = £24.58 (2 shades)
11 Superficial soft-tissue
injuries and superficial
thrombophlebitis
Topical circulatory preparations
These preparations are used to improve circulation in
conditions such as bruising, superficial thrombophlebitis,
chilblains and varicose veins but are of little value.
Chilblains are best managed by avoidance of exposure to
cold; neither systemic nor topical vasodilator therapy is
established as being effective.
Warts and calluses 1055
HEPARINOIDS
Heparinoid
INDICATIONS AND DOSE
Superficial thrombophlebitis | Bruising | Haematoma
TO THE SKIN
▶ Adult: Apply up to 4 times a day
l CONTRA-INDICATIONS Should not be used on large areas
of skin, broken or sensitive skin, or mucous membranes
l LESS SUITABLE FOR PRESCRIBING Hirudoid® is less
suitable for prescribing.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream 13
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens)
Skin
▶ Hirudoid (Genus Pharmaceuticals Ltd)
Heparinoid 3 mg per 1 gram Hirudoid 0.3% cream | 50 gram p
£3.99 DT price = £3.99
Gel
EXCIPIENTS: May contain Fragrances, propylene glycol
▶ Hirudoid (Genus Pharmaceuticals Ltd)
Heparinoid 3 mg per 1 gram Hirudoid 0.3% gel | 50 gram p £3.99
DT price = £3.99
12 Warts and calluses
Warts and calluses
Warts (verrucas) are caused by a human papillomavirus,
which most frequently affects the hands, feet (plantar
warts), and the anogenital region; treatment usually relies
on local tissue destruction. Warts may regress on their own
and treatment is required only if the warts are painful,
unsightly, persistent, or cause distress.
Preparations of salicylic acid p. 1057, formaldehyde,
glutaraldehyde or silver nitrate p. 1056 are available for
purchase by the public; they are suitable for the removal of
warts on hands and feet. Salicylic acid is a useful keratolytic
which may be considered first-line; it is also suitable for the
removal of corns and calluses. Preparations of salicylic acid
in a collodion basis are available but some patients may
develop an allergy to colophony in the formulation;
collodion should be avoided in children allergic to elastic
adhesive plaster. Cryotherapy causes pain, swelling, and
blistering, and may be no more effective than topical
salicylic acid in the treatment of warts.
Anogenital warts
The treatment of anogenital warts (condylomata acuminata)
should be accompanied by screening for other sexually
transmitted infections. Podophyllotoxin (the major active
ingredient of podophyllum) may be used for soft, non-
keratinised external anogenital warts. Patients with a limited
number of external warts or keratinised lesions may be
better treated with cryotherapy or other forms of physical
ablation.
Imiquimod cream p. 1057 is licensed for the treatment of
external anogenital warts; it may be used for both
keratinised and non-keratinised lesions. It is also licensed
for the treatment of superficial basal cell carcinoma and
actinic keratosis.
Inosine pranobex p. 550 is licensed for adjunctive
treatment of genital warts but it has been superseded by
more effective drugs.
 1056 Warts and calluses BNF 70

ALDEHYDES AND DERIVATIVES WARTICON ® CREAM

Condylomata acuminata affecting the penis or the female
Formaldehyde external genitalia
TO THE SKIN
INDICATIONS AND DOSE ▶ Adult: Apply twice daily for 3 consecutive days,
Warts, particularly plantar warts treatment may be repeated at weekly intervals if
TO THE SKIN necessary for a total of four 3-day treatment courses,
▶ Child: Apply twice daily direct medical supervision for lesions greater than
▶ Adult: Apply twice daily 4 cm2
WARTICON ® LIQUID
l CAUTIONS Impaired peripheral circulation . not suitable
Condylomata acuminata affecting the penis or the female
for application to anogenital region . not suitable for external genitalia
application to face . not suitable for application to large
areas . patients with diabetes at risk of neuropathic ulcers
TO THE SKIN
. protect surrounding skin and avoid broken skin . ▶ Adult: Apply twice daily for 3 consecutive days,
treatment may be repeated at weekly intervals if
significant peripheral neuropathy
necessary for a total of four 3-day treatment courses,
SIDE-EFFECTS Skin irritation . skin ulceration (with high
13 l
concentrations)
direct medical supervision for lesions greater than
4 cm2, maximum 50 single applications (‘loops’) per
session (consult product literature)
Skin

l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order l CAUTIONS Avoid normal skin . avoid open wounds . keep
manufacturers include: liquid away from face . very irritant to eyes
Liquid l SIDE-EFFECTS Local irritation
▶ FORMALDEHYDE (Non-proprietary) l PREGNANCY Avoid.
Formaldehyde 40 mg per 1 ml Formaldehyde (Buffered) 4%
solution | 1000 ml £3.56–£3.90 l BREAST FEEDING Avoid.
Gel l MEDICINAL FORMS
▶ Veracur (Typharm Ltd) There can be variation in the licensing of different medicines
Formaldehyde 7.5 mg per 1 gram Veracur 0.75% gel | containing the same drug.
15 gram G £2.41
Liquid
CAUTIONARY AND ADVISORY LABELS 15
▶ Condyline (Takeda UK Ltd)
Glutaraldehyde Podophyllotoxin 5 mg per 1 ml Condyline 0.5% solution |
3.5 ml P £14.49
INDICATIONS AND DOSE ▶ Warticon (Stiefel Laboratories (UK) Ltd)
Warts, particularly plantar warts Podophyllotoxin 5 mg per 1 ml Warticon 0.5% solution |
3 ml P £14.86
TO THE SKIN
Cream
▶ Child: Apply twice daily EXCIPIENTS: May contain Butylated hydroxyanisole, cetostearyl alcohol
▶ Adult: Apply twice daily (including cetyl and stearyl alcohol), hydroxybenzoates (parabens),
sorbic acid
l CAUTIONS Not for application to anogenital areas . not for ▶ Warticon (Stiefel Laboratories (UK) Ltd)
application to face . not for application to mucosa . Podophyllotoxin 1.5 mg per 1 gram Warticon 0.15% cream |
protect surrounding skin 5 gram P £17.83 DT price = £17.83
l SIDE-EFFECTS Rashes . skin irritation (discontinue if
severe) . stains skin brown CAUSTIC DRUGS
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
Silver nitrate
containing the same drug. INDICATIONS AND DOSE
Paint Common warts
▶ Glutarol (Dermal Laboratories Ltd)
TO THE SKIN
Glutaraldehyde 100 mg per 1 ml Glutarol 10% cutaneous
solution | 10 ml p £2.07 DT price = £2.07 ▶ Child: Apply every 24 hours for up to 3 applications,
apply moistened caustic pencil tip for 1–2 minutes.
Instructions in proprietary packs generally incorporate
ANTIMITOTICS
advice to remove dead skin before use by gentle filing
and to cover with adhesive dressing after application
Podophyllotoxin ▶ Adult: Apply every 24 hours for up to 3 applications,
INDICATIONS AND DOSE apply moistened caustic pencil tip for 1–2 minutes.
Instructions in proprietary packs generally incorporate
CONDYLINE ®
advice to remove dead skin before use by gentle filing
Condylomata acuminata affecting the penis or the female and to cover with adhesive dressing after application
external genitalia
Verrucas
TO THE SKIN
TO THE SKIN
▶ Adult: Apply twice daily for 3 consecutive days,
▶ Child: Apply every 24 hours for up to 6 applications,
treatment may be repeated at weekly intervals if
apply moistened caustic pencil tip for 1–2 minutes.
necessary for a total of five 3-day treatment courses,
Instructions in proprietary packs generally incorporate
direct medical supervision for lesions in the female
advice to remove dead skin before use by gentle filing
and for lesions greater than 4 cm2 in the male,
and to cover with adhesive dressing after application
maximum 50 single applications (‘loops’) per session
▶ Adult: Apply every 24 hours for up to 6 applications,
(consult product literature)
apply moistened caustic pencil tip for 1–2 minutes.
 BNF 70 Warts and calluses 1057

Instructions in proprietary packs generally incorporate
advice to remove dead skin before use by gentle filing
and to cover with adhesive dressing after application
Umbilical granulomas
TO THE SKIN
▶ Child: Apply moistened caustic pencil tip (usually
containing silver nitrate 40%) for 1–2 minutes, protect
surrounding skin with soft paraffin
▶ Adult: Apply moistened caustic pencil tip (usually
containing silver nitrate 40%) for 1–2 minutes, protect
surrounding skin with soft paraffin
l CAUTIONS Avoid broken skin . not suitable for application
to ano-genital region . not suitable for application to face
. not suitable for application to large areas . protect
surrounding skin
SIDE-EFFECTS Chemical burns on surrounding skin .
l
stains skin
PATIENT AND CARER ADVICE Patients should be advised
with nostrils . avoid open wounds . immunosuppressed
patients . not suitable for internal genital warts .
uncircumcised males (risk of phimosis or stricture of
foreskin)
l SIDE-EFFECTS
▶ Common or very common Burning sensation . erosion .
erythema . excoriation . headache . influenza-like
symptoms . itching . local reactions . myalgia . oedema .
scabbing
▶ Uncommon Alopecia . local ulceration
▶ Rare Cutaneous lupus erythematosus-like effect .
Stevens-Johnson syndrome
▶ Very rare Dysuria
▶ Frequency not known Permanent hyperpigmentation .
permanent hypopigmentation
l CONCEPTION AND CONTRACEPTION May damage latex
condoms and diaphragms.
13
l PREGNANCY No evidence of teratogenicity or toxicity in
animal studies; manufacturer advises caution.

Skin
l
that silver nitrate may stain fabric. l BREAST FEEDING No information available.
l MEDICINAL FORMS l DIRECTIONS FOR ADMINISTRATION
There can be variation in the licensing of different medicines ALDARA ®
containing the same drug. Forms available from special-order Important Should be rubbed in and allowed to stay on the
manufacturers include: liquid treated area for 6–10 hours for warts or for 8 hours for
Stick basal cell carcinoma and actinic keratosis, then washed
▶ Avoca (Bray Group Ltd) off with mild soap and water (uncircumcised males
Silver nitrate 400 mg per 1 gram Avoca 40% silver nitrate treating warts under foreskin should wash the area daily).
pencils | 1 applicator p £1.01
The cream should be washed off before sexual contact.
Silver nitrate 750 mg per 1 gram Avoca 75% silver nitrate
applicators | 100 applicator p £43.73 ZYCLARA ®
Avoca 75% silver nitrate applicators with thick handles | Important Should be rubbed in and allowed to stay on the
50 applicator p £42.49 treated area for 8 hours, then washed off with mild soap
Silver nitrate 950 mg per 1 gram Avoca 95% silver nitrate and water.
applicators | 100 applicator p £43.73
Avoca 95% silver nitrate pencils | 1 applicator p £1.96 DT price = l MEDICINAL FORMS
£2.44 | 12 applicator p £23.04 There can be variation in the licensing of different medicines
Avoca wart and verruca treatment set | 1 applicator p £2.44 DT containing the same drug.
price = £2.44 | 6 applicator p £14.37
Cream
CAUTIONARY AND ADVISORY LABELS 10
IMMUNE RESPONSE MODIFIERS EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), hydroxybenzoates (parabens), polysorbates
Imiquimod ▶ Aldara (Meda Pharmaceuticals Ltd)
Imiquimod 50 mg per 1 gram Aldara 5% cream 250mg sachets |
INDICATIONS AND DOSE 12 sachet P £48.60 DT price = £48.60
▶ Zyclara (Meda Pharmaceuticals Ltd)
ALDARA ®
Imiquimod 37.5 mg per 1 gram Zyclara 3.75% cream 250mg
Warts (external genital and perianal) sachets | 28 sachet P £113.00
TO THE SKIN
▶ Adult: Apply 3 times a week until lesions resolve SALICYLATES
(maximum 16 weeks), to be applied thinly at night
Superficial basal cell carcinoma Salicylic acid
TO THE SKIN
▶ Adult: Apply daily for 5 nights of each week for INDICATIONS AND DOSE
6 weeks, to be applied to lesion and 1 cm beyond it, OCCLUSAL ®
assess response 12 weeks after completing treatment Common and plantar warts
Actinic keratosis TO THE LESION
TO THE SKIN ▶ Child: Apply daily, treatment may need to be
▶ Adult: Apply 3 times a week for 4 weeks, to be applied continued for up to 3 months
to lesion at night, assess response after a 4 week ▶ Adult: Apply daily, treatment may need to be
treatment-free interval; repeat 4-week course if continued for up to 3 months
lesions persist, maximum 2 courses VERRUGON ®
ZYCLARA ® For plantar warts
Actinic keratosis TO THE LESION
TO THE SKIN ▶ Child: Apply daily, treatment may need to be
▶ Adult: Apply once daily for 2 weeks, to be applied at continued for up to 3 months
bedtime to lesion on face or balding scalp, repeat ▶ Adult: Apply daily, treatment may need to be
course after a 2-week treatment-free interval, assess continued for up to 3 months
response 8 weeks after second course; maximum
2 sachets per day l UNLICENSED USE Not licensed for use in children under 2
years.
l CAUTIONS Autoimmune disease . avoid broken skin . avoid l CAUTIONS Avoid broken skin . impaired peripheral
contact with eyes . avoid contact with lips . avoid contact circulation . not suitable for application to anogenital
 1058 Warts and calluses BNF 70

region . not suitable for application to face . not suitable
for application to large areas . patients with diabetes at
risk of neuropathic ulcers . significant peripheral
neuropathy
l SIDE-EFFECTS Skin irritation . skin ulceration (with high
concentrations)
l PATIENT AND CARER ADVICE Advise patient to apply
carefully to wart and to protect surrounding skin (e.g.
with soft paraffin or specially designed plaster); rub wart
surface gently with file or pumice stone once weekly.
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: paint, cream, ointment, liquid
Liquid
CAUTIONARY AND ADVISORY LABELS 15
13 ▶ Occlusal (Alliance Pharmaceuticals Ltd)
Salicylic acid 260 mg per 1 ml Occlusal 26% solution | 10 ml
£3.56 DT price = £3.56
Skin
l MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment, cream
Gel
CAUTIONARY AND ADVISORY LABELS 15
▶ Cuplex (Crawford Healthcare Ltd)
Lactic acid 40 mg per 1 gram, Salicylic acid 110 mg per 1
gram Cuplex Verruca gel | 5 gram G £2.88 DT price = £2.88
▶ Salatac (Dermal Laboratories Ltd)
Lactic acid 40 mg per 1 gram, Salicylic acid 120 mg per 1
gram Salatac gel | 8 gram p £2.98 DT price = £2.98
▶ Brands may include Bazuka gel
Paint
CAUTIONARY AND ADVISORY LABELS 15
▶ LACTIC ACID WITH SALICYLIC ACID (Non-proprietary)
Lactic acid 167 mg per 1 gram, Salicylic acid 167 mg per 1
gram Salicylic acid 16.7% / Lactic acid 16.7% paint | 10 ml p no
price available | 15 ml p no price available
p ▶ Duofilm (GlaxoSmithKline UK Ltd)

Lactic acid 150 mg per 1 gram, Salicylic acid 167 mg per 1

Ointment gram Duofilm paint | 15 ml p £2.25
▶ SALICYLIC ACID (Non-proprietary) ▶ Salactol (Dermal Laboratories Ltd)
Salicylic acid 20 mg per 1 gram, Wool alcohols ointment 980 mg Lactic acid 167 mg per 1 gram, Salicylic acid 167 mg per 1
per 1 gram Salicylic acid 2% ointment | 450 gram G £8.08 gram Salactol paint | 10 ml p £1.71
▶ Verrugon (Optima Consumer Health Ltd)
Salicylic acid 500 mg per 1 gram Verrugon complete 50%
ointment | 6 gram p £3.12
▶ Brands may include Pickles 50% ointment, Wartex 50% ointment
Gel
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Colophony
▶ Bazuka Extra Strength (Dendron Ltd)
Salicylic acid 260 mg per 1 gram Bazuka Extra Strength 26% gel |
5 gram p £3.95 DT price = £3.95
Medicated plaster
▶ SALICYLIC ACID (Non-proprietary)
Salicylic acid 400 mg per 1 gram 30 plaster G £2.91
▶ Brands may include Scholl Corn Removal

Salicylic acid with lactic acid

The properties listed below are those particular to the
combination only. For the properties of the components please
consider, salicylic acid p. 1057.

INDICATIONS AND DOSE

CUPLEX ®
Plantar and mosaic warts | Corns | Calluses
TO THE LESION
▶ Adult: Apply twice daily
DUOFILM ®
Plantar and mosaic warts
TO THE LESION
▶ Adult: Apply daily
SALATAC ®
Warts | Verrucas | Corns | Calluses
TO THE LESION
▶ Adult: Apply daily
SALACTOL ®
Warts (particularly plantar warts) | Verrucas | Corns |
Calluses
TO THE LESION
▶ Adult: Apply daily

l PRESCRIBING AND DISPENSING INFORMATION

CUPLEX ® AND SALACTOL ®
Preparations of salicylic acid in a collodion basis are
available but some patients may develop an allergy to
colophony in the formulation.